Higher risk of in-hospital mortality and hepatic encephalopathy during weekend admission in Transjugular Intrahepatic Portosystemic Shunt procedure - 16/06/24
, SeungEun Lee a, William Rienas a, Shawn Sarin bHighlights |
· | This study unveiled a significant relationship between the day of patient admission, whether it be on a weekday or a weekend, and the risk of mortality and morbidity after Transjugular Intrahepatic Portosystemic Shunt (TIPS) procedure. |
· | Patients admitted over the weekend showed higher incidences of mortality, hepatic encephalopathy (HE), acute kidney injury (AKI), and transfers to alternate hospital facilities. These patients also exhibited longer times from admission to surgery, extended hospital stays, and higher overall hospital costs. |
· | These insights highlight the existing inequality in healthcare provision during weekends in patients who undergo TIPS procedures. |
· | Eliminating delays in treatment associated with the weekend effect may bridge this gap; such measures may encompass assuring sufficient staffing and improving weekend access to diagnostic and treatment procedures. |
· | By addressing these issues, we can strive to deliver consistent and high-quality care to all patients, regardless of the day of admission. |
Abstract |
Objectives |
Transjugular intrahepatic portosystemic shunt (TIPS) is a procedure used to alleviate portal hypertension in patients with decompensated liver cirrhosis. The weekend effect refers to a higher risk of adverse outcomes associated with procedures performed on weekends compared to weekdays. The goal of this study is to determine whether a weekend effect is evident in TIPS procedures.
Materials and Method |
The study identified patients who underwent TIPS procedures in the NIS database from 2015 to 2020. Patients who were admitted on the weekday or weekends were classified into two cohorts. Preoperative variables, including demographics, comorbidities, primary payer status, and hospital characteristics, were noted. Multivariable analysis was used to assess outcomes.
Results |
Compared to patients admitted on the weekdays, weekend patients had higher in-hospital mortality (12.87 % vs. 7.96 %, aOR = 1.62, 95 CI 1.32–1.00, p < 0.01), hepatic encephalopathy (33.24 % vs. 26.18 %, aOR = 1.41, 95 CI 1.23–1.63, p < 0.01), acute kidney injury (39.03 % vs. 28.36 %, aOR = 1.68, 95 CI 1.46–1.93, p < 0.01), and transfer out (15.91 % vs. 12.76 %, aOR=1.33, 95 CI 1.11–1.60, p < 0.01). It was also found that weekend patients had longer wait from admission to operation (3.83 ± 0.15 days vs 2.82 ± 0.07 days, p < 0.01), longer LOS (11.22 ± 0.33 days vs 8.38 ± 0.15 days, p < 0.01), and higher total hospital charge (219,973 ± 7,352 dollars vs 172,663 ± 3,183 dollars, p < 0.01).
Conclusion |
Our research unveiled a significant relationship between weekend admission and a higher risk of mortality and morbidity post-TIPS procedure. Eliminating delays in treatment associated with the weekend effect may mitigate this gap to deliver consistent and high-quality care to all patients.
Il testo completo di questo articolo è disponibile in PDF.Keywords : Transjugular intrahepatic portosystemic shunt, Weekend, Portal hypertension, Hepatic encephalopathy
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Vol 48 - N° 7
Articolo 102396- Agosto 2024 Ritorno al numero
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