The ‘Weekend Effect’ in adult patients who receive extracorporeal cardiopulmonary resuscitation after in- and out-of-hospital cardiac arrest

Lunz, Dirk; Camboni, Daniele; Philipp, Alois; Flörchinger, Bernhard; Terrazas, Armando; Müller, Thomas; Schmid, Çhristof; Diez, Claudius

doi:10.1016/j.resplu.2020.100044

Cited by 6 publications

(5 citation statements)

References 25 publications

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“…Another Korean study reported lower survival rates on weekends along with an increase in ECMO-related complications, such as wound infections, bleeding at the cannulation site, and limb ischemia [ 7 ]. In contrast, a different study indicated that the interval from CPR to ECMO initiation was a predictor of in-hospital mortality; however, the performance of ECPR on weekends did not emerge as a significant factor in the logistic regression analysis [ 10 ]. Thus, the influence of weekends on ECPR outcomes appears to be closely linked to the time elapsed from the arrest to the initiation of ECPR.…”

Section: Discussionmentioning

confidence: 99%

The “Weekend Effect” in Extracorporeal Cardiopulmonary Resuscitation

Shin,

Cho,

Kang

2024

J Chest Surg

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Background The phenomenon known as the “weekend effect” impacts various medical disciplines. We compared outcomes between regular hours and off hours to investigate the presence of the weekend effect in extracorporeal cardiopulmonary resuscitation (ECPR). Methods Between January 2018 and December 2020, 159 patients at our center were treated with veno-arterial extracorporeal membrane oxygenation (ECMO) for cardiac arrest. We assessed the time required for ECMO preparation, the rate of successful weaning, and the rate of in-hospital mortality. These factors were compared among regular hours (“daytime” weekdays from 700 AM–700 PM), off hours on weekdays (“nighttime” weekdays from 700 PM–700 AM), and off hours on weekends and holidays (“weekend” Fridays at 700 PM to Mondays at 700 AM). Results The time from the recognition of cardiac arrest to the arrival of the ECMO team was shortest for the daytime group and longest for those treated over the weekend (daytime, 10.0 minutes; nighttime, 12.5 minutes; weekend, 15.0 minutes; p=0.064). The time from the ECMO team’s arrival to ECMO initiation was shortest for the daytime and longest for the nighttime group (daytime, 13.0 minutes; nighttime, 18.5 minutes; weekend, 14.0 minutes; p=0.028). No significant difference was observed in the rate of successful ECMO weaning (daytime, 48.3%; nighttime, 39.5%; weekend, 36.1%; p=0.375). Conclusion In situations involving CPR, the time to arrival of the ECMO team was longer during off hours. Furthermore, ECMO insertion required more time at night than during the other periods. These findings warrant specific training in decision-making and emergent ECMO insertion.

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Section: Discussionmentioning

confidence: 99%

The “Weekend Effect” in Extracorporeal Cardiopulmonary Resuscitation

Shin,

Cho,

Kang

2024

J Chest Surg

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“…The main goal of this study was to investigate whether there is a weekday-dependency of long-term patient outcome after oncological resections of gastrointestinal malignancies in Germany. To date, the weekday effect in Germany has mainly been studied for emergency procedures and organ transplants 33 – 38 .…”

Section: Discussionmentioning

confidence: 99%

Weekday-dependent long-term outcomes in gastrointestinal cancer surgery: a German population-based retrospective cohort study

Maier,

Schölch,

Zhu

et al. 2023

International Journal of Surgery

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Background: For most solid cancers, surgery represents the mainstay of curative treatment. Several studies investigating the effects of the weekday of surgery (WOS) on patient outcomes have yielded conflicting results. Barmer, the second-largest health insurance company in Germany, serves roughly 10% of the German population. We have used the Barmer database to evaluate how the weekday on which the surgery is performed influences long-term oncologic outcomes. Methods: For this retrospective cohort study, the Barmer database was used to investigate the effect of the WOS (Monday–Friday) on outcomes following oncological resections of the colorectum (n=49,003), liver (n=1,302), stomach (n=5027), esophagus (n=1126), and pancreas (n=6,097). In total, 62,555 cases from 2008 to 2018 were included in the analysis. The endpoints were overall survival (OS), postoperative complications, and necessity for therapeutic interventions or re-operations. We furthermore examined whether the annual caseload or certification as a cancer center influenced the weekday effect. Results: We observed a significantly impaired OS for patients receiving gastric or colorectal resections on a Monday. Colorectal surgery performed on Mondays was associated with more postoperative complications and higher probability of re-operations. The annual caseload or a certification as a colorectal cancer center had no bearing on the observed weekday effect. There is evidence that hospitals schedule older patients with more comorbidities earlier in the week, possibly explaining these findings. Conclusion: This is the first study investigating the influence of the WOS on long-term survival in Germany. Our findings indicate that, in the German healthcare system, patients undergoing colorectal cancer surgery on Mondays have more postoperative complications and, therefore, require significantly more re-operations, ultimately lowering OS. This surprising finding appears to reflect an attempt to schedule patients with higher postoperative risk earlier in the week as well as semi-elective patients admitted on weekends scheduled for surgery on the next Monday.

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“…For example, we found that missed opportunities were more strongly associated with healthcare visits that occurred on weekends. Many different adverse healthcare outcomes are linked to weekend-based healthcare [ 30 , 31 , 32 ], thus it is not surprising that diagnostic delays are also more common. In terms of practice settings, missed opportunities were more commonly associated with outpatient visits and ED visits compared to hospitalizations.…”

Section: Discussionmentioning

confidence: 99%

Frequency and Duration of, and Risk Factors for, Diagnostic Delays Associated with Histoplasmosis

Arakkal

Koeneman

Cavanaugh

et al. 2022

JoF

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Histoplasmosis is often confused with other diseases leading to diagnostic delays. We estimated the incidence, length of, and risk factors for, diagnostic delays associated with histoplasmosis. Using data from IBM Marketscan, 2001–2017, we found all patients with a histoplasmosis diagnosis. We calculated the number of visits that occurred prior to the histoplasmosis diagnosis and the number of visits with symptomatically similar diagnoses (SSDs). Next, we estimated the number of visits that represented a delay using a simulation-based approach. We also computed the number of potential opportunities for diagnosis that were missed for each patient and the length of time between the first opportunity and the diagnosis. Finally, we identified risk factors for diagnostic delays using a logistic regression model. The number of SSD-related visits increased significantly in the 97 days prior to the histoplasmosis diagnosis. During this period, 97.4% of patients had a visit, and 90.1% had at least one SSD visit. We estimate that 82.9% of patients with histoplasmosis experienced at least one missed diagnostic opportunity. The average delay was 39.5 days with an average of 4.0 missed opportunities. Risk factors for diagnostic delays included prior antibiotic use, history of other pulmonary diseases, and emergency department and outpatient visits, especially during weekends. New diagnostic approaches for histoplasmosis are needed.

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The ‘Weekend Effect’ in adult patients who receive extracorporeal cardiopulmonary resuscitation after in- and out-of-hospital cardiac arrest

Cited by 6 publications

References 25 publications

The “Weekend Effect” in Extracorporeal Cardiopulmonary Resuscitation

The “Weekend Effect” in Extracorporeal Cardiopulmonary Resuscitation

Weekday-dependent long-term outcomes in gastrointestinal cancer surgery: a German population-based retrospective cohort study

Frequency and Duration of, and Risk Factors for, Diagnostic Delays Associated with Histoplasmosis

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