Aims: Acute aortic dissection or rupture (AARD) represent life-threatening emergency, characterized by high mortality. The aim of this study was to determine whether an increased weekend (WE) mortality for AARD was confirmed in the entire Italy. Methods: The study included all emergency AARD admissions recorded in the National Discharge Hospital database, Italian Ministry of Health (2008-2010). Events were analyzed according to day-of-week of admission and occurrence on WE (midnight Friday to midnight Sunday) vs. weekdays (WD). Festive days were considered as WE. Results: Out of 164,321 admissions with the ICD9-CM codes of aneurysms, we first extracted 66,298 emergency admissions. Of these, 17,319 cases, referring to 15,137 patients (mean age 71.113 years), 11,024 males and 4113 females, had acute AARD codes. AARD admissions were most frequent on Monday (16.7%) and less frequent on Saturday (12.1%). A significantly increased mean lengh-of-stay (LOS) in WD versus WE admissions was found for all patients (p=0.005) and patients died during hospitalization (p=0.011), but not for patients discharged alive (p=NS). Mortality was significantly higher in females, aged over 80 years, subjects admitted on first event, and those admitted on WE. In-hospital mortality rate within 24 hours from admission was higher among patients admitted on WE vs. WD (52.2% vs. 47.4%, p=0.001). Logistic analysis found an increased in-hospital risk of death related to: admission on WE [OR 1.34, p<0.001], female gender [OR 1.19, p<0.001], increasing age [60-69 years: OR 1.60, p<0.001; 70-79 years: OR 2.46, p<0.001; >80 years: OR 4.67, p<0.001], first event and admission on WE [OR 1.22, p<0.001]. Logistic regression analysis (including WD/WE admission, gender, age subgroups, first or successive admission, diagnostic and therapeutic procedures) confirmed WE admission as independent risk factor for increased mortality (OR 1.34, p<0.001). Conclusions: This study provides further confirmation that AARD patientsurgently hospitalized on WE show highly significant increase risk of death than those admitted on WD. Moreover, they undergo less diagnostic examinations, and WE admissions remains an independent risk factor for mortality, regardless of sex, age, site and type of dissection or rupture.
Outcomes of weekend versus weekday admission for acute aortic dissection or rupture: A retrospective study on the Italian National Hospital Database.
VOLPATO, Stefano;FABBIAN, Fabio;GASBARRO, Vincenzo;MANFREDINI, Roberto
2013
Abstract
Aims: Acute aortic dissection or rupture (AARD) represent life-threatening emergency, characterized by high mortality. The aim of this study was to determine whether an increased weekend (WE) mortality for AARD was confirmed in the entire Italy. Methods: The study included all emergency AARD admissions recorded in the National Discharge Hospital database, Italian Ministry of Health (2008-2010). Events were analyzed according to day-of-week of admission and occurrence on WE (midnight Friday to midnight Sunday) vs. weekdays (WD). Festive days were considered as WE. Results: Out of 164,321 admissions with the ICD9-CM codes of aneurysms, we first extracted 66,298 emergency admissions. Of these, 17,319 cases, referring to 15,137 patients (mean age 71.113 years), 11,024 males and 4113 females, had acute AARD codes. AARD admissions were most frequent on Monday (16.7%) and less frequent on Saturday (12.1%). A significantly increased mean lengh-of-stay (LOS) in WD versus WE admissions was found for all patients (p=0.005) and patients died during hospitalization (p=0.011), but not for patients discharged alive (p=NS). Mortality was significantly higher in females, aged over 80 years, subjects admitted on first event, and those admitted on WE. In-hospital mortality rate within 24 hours from admission was higher among patients admitted on WE vs. WD (52.2% vs. 47.4%, p=0.001). Logistic analysis found an increased in-hospital risk of death related to: admission on WE [OR 1.34, p<0.001], female gender [OR 1.19, p<0.001], increasing age [60-69 years: OR 1.60, p<0.001; 70-79 years: OR 2.46, p<0.001; >80 years: OR 4.67, p<0.001], first event and admission on WE [OR 1.22, p<0.001]. Logistic regression analysis (including WD/WE admission, gender, age subgroups, first or successive admission, diagnostic and therapeutic procedures) confirmed WE admission as independent risk factor for increased mortality (OR 1.34, p<0.001). Conclusions: This study provides further confirmation that AARD patientsurgently hospitalized on WE show highly significant increase risk of death than those admitted on WD. Moreover, they undergo less diagnostic examinations, and WE admissions remains an independent risk factor for mortality, regardless of sex, age, site and type of dissection or rupture.I documenti in SFERA sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
