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Acta Neurochirurgica
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Acta Neurochirurgica
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Impact of the weekend effect on outcome after microsurgical clipping of ruptured intracranial aneurysms

Authors: Lukas Goertz; Christoph Kabbasch; Muriel Pflaeging; Lenhard Pennig; Kai Roman Laukamp; Marco Timmer; Hanna Styczen; +3 Authors

Impact of the weekend effect on outcome after microsurgical clipping of ruptured intracranial aneurysms

Abstract

Abstract Background The “weekend effect” describes the assumption that weekend and/or on-call duty admission of emergency patients is associated with increased morbidity and mortality rates. For aneurysmal subarachnoid hemorrhage, we investigated, whether presentation out of regular working hours and microsurgical clipping at nighttime correlates with worse patient outcome. Methods This is a retrospective review of consecutive patients that underwent microsurgical clipping of an acutely ruptured aneurysm at our institution between 2010 and 2019. Patients admitted during (1) regular working hours (Monday–Friday, 08:00–17:59) and (2) on-call duty and microsurgical clipping performed during (a) daytime (Monday–Sunday, 08:00–17:59) and (b) nighttime were compared regarding the following outcome parameters: operation time, treatment-related complications, vasospasm, functional outcome, and angiographic results. Results Among 157 enrolled patients, 104 patients (66.2%) were admitted during on-call duty and 48 operations (30.6%) were performed at nighttime. Admission out of regular hours did not affect cerebral infarction (p = 0.545), mortality (p = 0.343), functional outcome (p = 0.178), and aneurysm occlusion (p = 0.689). Microsurgical clipping at nighttime carried higher odds of unfavorable outcome at discharge (OR: 2.3, 95%CI: 1.0–5.1, p = 0.039); however, there were no significant differences regarding the remaining outcome parameters. After multivariable adjustment, clipping at nighttime did not remain as independent prognosticator of short-term outcome (OR: 2.1, 95%CI: 0.7–6.2, p = 0.169). Conclusions Admission out of regular working hours and clipping at nighttime were not independently associated with poor outcome. The adherence to standardized treatment protocols might mitigate the “weekend effect.”

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Keywords

Male, Original Article - Vascular Neurosurgery - Aneurysm, Microsurgery, Night Care, Endovascular Procedures, Medizin, Angiography, Intracranial Aneurysm, Cerebral Infarction, Aneurysm, Ruptured, Middle Aged, Subarachnoid Hemorrhage, Neurosurgical Procedures, Aged [MeSH] ; Intracranial Aneurysm/complications [MeSH] ; Clipping ; Night ; Angiography [MeSH] ; Male [MeSH] ; Subarachnoid Hemorrhage/surgery [MeSH] ; Aneurysm, Ruptured/surgery [MeSH] ; Female [MeSH] ; Functional outcome ; Endovascular Procedures/methods [MeSH] ; Humans [MeSH] ; Subarachnoid Hemorrhage/mortality [MeSH] ; Treatment Outcome [MeSH] ; Retrospective Studies [MeSH] ; Middle Aged [MeSH] ; Night Care [MeSH] ; Aneurysm, Ruptured/mortality [MeSH] ; Subarachnoid Hemorrhage/etiology [MeSH] ; Intracranial Aneurysm/mortality [MeSH] ; Original Article - Vascular Neurosurgery - Aneurysm ; Neurosurgical Procedures/methods [MeSH] ; After-Hours Care [MeSH] ; Modified Rankin scale ; Cerebral Infarction/mortality [MeSH] ; Aneurysm, Ruptured/complications [MeSH] ; Vascular Neurosurgery – Aneurysm ; Patient Admission [MeSH] ; Cerebral Infarction/prevention ; Cerebral infarction ; Microsurgery [MeSH] ; Angiographic outcome ; Intracranial Aneurysm/surgery [MeSH], Patient Admission, Treatment Outcome, After-Hours Care, Humans, Female, Aged, Retrospective Studies

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    This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
    12
    popularity
    This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
    Top 10%
    influence
    This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
    Average
    impulse
    This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
    Top 10%
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selected citations
These citations are derived from selected sources.
This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
12
Top 10%
Average
Top 10%
Green
hybrid