A. K. Jundoria1, B. Grant1, O. A. Olufajo1, E. De La Cruz1, D. Metcalfe2, M. Williams1, E. E. Cornwell1, K. Hughes1 1Howard University College Of Medicine,Washington, DC, USA 2University of Oxford,Nuffield Department Of Orthopaedics, Rheumatology And Musculoskeletal Sciences (NDORMS),Oxford, OX3 9BU, United Kingdom
Introduction: Numerous studies have suggested that compared to the weekday, weekend admissions may be associated with worse patient outcomes across a range of patient diagnoses. Lower extremity vascular trauma is increasingly common and requires immediate/urgent surgical intervention. Although this weekend effect has been reported for several domains, it has not been elucidated in vascular trauma. The objective of this study was to determine if there is a weekend effect in patient outcomes of lower extremity vascular trauma (LEVT).
Methods: Retrospective data was retrieved from the National Inpatient Sample database, a 20% stratified sample of the United States inpatient population, from 2005 – 2014. Patients ages 18 and above with International Classification of Diseases, 9th Edition codes indicating trauma to the lower extremity vessels were included. Patients and hospital characteristics were extracted including age, sex, race, insurance type, median household income, Injury Severity Score, Charlson comorbidity score, Abbreviated Injury Scale (AIS) for extremity body region, and location/teaching status of hospital. Outcomes (mortality, amputation, hospital length of stay, and discharge disposition) among patients admitted on weekdays versus patients admitted on weekends were measured. Independent factors associated with outcomes were identified using multivariable regression models. Supplementary analyses were performed using patients with only isolated LEVT, which was defined by AIS of zero in every body region except extremity.
Results: There were 9282 patient records with LEVT (2866 admitted on the weekend vs. 6416 admitted on the weekday). Compared to patients admitted on the weekday, patients admitted on the weekends were more likely to be younger than 45 years old (67.6% vs. 55.4%), males (80.5% vs. 74.6%), and uninsured (22.1% vs. 17.2%) [all p < 0.001]. Comparison of outcomes for patients on weekend vs. weekday showed mortality of 3.80% vs. 3.29% [p = 0.209], amputation rates of 7.85% vs. 7.19% [p = 0.258], hospital length of stay (LOS) of 15.5 days vs. 13.8 days [p = 0.009], and discharge home rates of 57.3% vs. 56.1% [p = 0.271]. The multivariable regressions showed the following outcomes for weekend vs. weekday admissions: mortality (Odds Ratio, OR [95% Confidence Interval, CI]); 1.06 [0.79-1.40], amputation (OR [95% CI]); 1.09 [0.89-1.30], discharge home (OR [95% CI]); 0.95 [0.85-1.06] and hospital LOS (predicted mean LOS [95% CI]); 0.33 [-0.34-1.00].
Conclusion: This study demonstrated there was no weekend effect identified in patients admitted with LEVT in the United States. This suggests that there is likely no difference in the level of care given to lower extremity vascular trauma patients, regardless of whether they present on a weekend or on a weekday.