TY - JOUR
T1 - Outcomes of nonelective weekend admissions for lower extremity ischemia
AU - Orandi, Babak J.
AU - Selvarajah, Shalini
AU - Orion, Kristine C.
AU - Lum, Ying Wei
AU - Perler, Bruce A.
AU - Abularrage, Christopher J.
N1 - Publisher Copyright:
Copyright © 2014 by the Society for Vascular Surgery.
PY - 2014
Y1 - 2014
N2 - Objective: A "weekend effect" has been demonstrated for a number of diagnoses, including many cardiovascular pathologies. Whether patients with lower extremity ischemia admitted over the weekend have inferior outcomes compared with those admitted on a weekday is unknown. Methods: Nonelective admissions for critical limb ischemia (CLI) and acute limb ischemia (ALI) from lower extremity thrombosis or embolism were identified in the 2005 to 2010 Nationwide Inpatient Sample, and outcomes were compared based on weekend vs weekday admission by using multiple logistic and linear regression. Results: Of the 63,768 patients identified with lower extremity vascular emergencies, 15.4% were admitted during the weekend. Patients admitted on the weekend were less likely to have CLI than those admitted on a weekday (51.2% vs 65.4%; P <.001) and were more likely to have ALI than patients admitted during a weekday (48.8% vs 34.5%; P <.001). Weekend admission was independently associated with a lower likelihood of revascularization (adjusted odds ratio [aOR], 0.90; 95% confidence interval [CI], 0.85-0.95; P <.001), a longer time until revascularization (3.09 days vs 2.75 days; P <.001), an increased likelihood of major amputation (aOR, 1.35; 95% CI, 1.19-1.53; P <.001), inhospital complications (aOR, 1.18; 95% CI, 1.11-1.25; P <.001), and discharge to a skilled nursing facility (aOR, 1.15; 95% CI, 1.06-1.25; P =.001), and a longer predicted length of stay (10.1 days vs 9.5 days; P <.001). There was no statistically significant association between weekend admission and in-hospital mortality (aOR, 1.15; 95% CI, 1.06-1.25; P =.10). Conclusions: Patients admitted on the weekend for lower extremity vascular emergencies are significantly more likely to experience adverse outcomes, including major amputation, than patients admitted on a weekday, independent of their presenting diagnosis with ALI or CLI. Further investigation into the etiologies of these differences is needed to address this disparity. These data raise questions about the proper staffing models to optimize urgent treatment of lower extremity vascular emergencies.
AB - Objective: A "weekend effect" has been demonstrated for a number of diagnoses, including many cardiovascular pathologies. Whether patients with lower extremity ischemia admitted over the weekend have inferior outcomes compared with those admitted on a weekday is unknown. Methods: Nonelective admissions for critical limb ischemia (CLI) and acute limb ischemia (ALI) from lower extremity thrombosis or embolism were identified in the 2005 to 2010 Nationwide Inpatient Sample, and outcomes were compared based on weekend vs weekday admission by using multiple logistic and linear regression. Results: Of the 63,768 patients identified with lower extremity vascular emergencies, 15.4% were admitted during the weekend. Patients admitted on the weekend were less likely to have CLI than those admitted on a weekday (51.2% vs 65.4%; P <.001) and were more likely to have ALI than patients admitted during a weekday (48.8% vs 34.5%; P <.001). Weekend admission was independently associated with a lower likelihood of revascularization (adjusted odds ratio [aOR], 0.90; 95% confidence interval [CI], 0.85-0.95; P <.001), a longer time until revascularization (3.09 days vs 2.75 days; P <.001), an increased likelihood of major amputation (aOR, 1.35; 95% CI, 1.19-1.53; P <.001), inhospital complications (aOR, 1.18; 95% CI, 1.11-1.25; P <.001), and discharge to a skilled nursing facility (aOR, 1.15; 95% CI, 1.06-1.25; P =.001), and a longer predicted length of stay (10.1 days vs 9.5 days; P <.001). There was no statistically significant association between weekend admission and in-hospital mortality (aOR, 1.15; 95% CI, 1.06-1.25; P =.10). Conclusions: Patients admitted on the weekend for lower extremity vascular emergencies are significantly more likely to experience adverse outcomes, including major amputation, than patients admitted on a weekday, independent of their presenting diagnosis with ALI or CLI. Further investigation into the etiologies of these differences is needed to address this disparity. These data raise questions about the proper staffing models to optimize urgent treatment of lower extremity vascular emergencies.
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U2 - 10.1016/j.jvs.2014.08.091
DO - 10.1016/j.jvs.2014.08.091
M3 - Article
C2 - 25441678
AN - SCOPUS:84925225045
SN - 0741-5214
VL - 60
SP - 1572-1579.e1
JO - Journal of vascular surgery
JF - Journal of vascular surgery
IS - 6
ER -