Mortality of major cardiovascular emergencies among patients admitted to hospitals on weekends as compared with weekdays in Taiwan

Background Several studies have found a so-called weekend effect that patients admitted at the weekends had worse clinical outcomes than patients admitted at the weekdays. We performed this retrospective cohort study to explore the weekend effect in four major cardiovascular emergencies in Taiwan. Methods The Taiwan National Health Insurance (NHI) claims database between 2005 and 2015 was used. We extracted 3811 incident cases of ruptured aortic aneurysm, 184,769 incident cases of acute myocardial infarction, 492,127 incident cases of ischemic stroke, and 15,033 incident cases of pulmonary embolism from 9,529,049 patients having at least one record of hospitalization in the NHI claims database within 2006 ~ 2014. Patients were classified as weekends or weekdays admission groups. Dates of in-hospital mortality and one-year mortality were obtained from the Taiwan National Death Registry. Results We found no difference in in-hospital mortality between weekend group and weekday group in patients with ruptured aortic aneurysm (45.4% vs 45.3%, adjusted odds ratio [OR] 1.01, 95% confidence interval [CI] 0.87–1.17, p = 0.93), patients with acute myocardial infarction (15.8% vs 16.2%, adjusted OR 0.98, 95% CI 0.95–1.00, p = 0.10), patients with ischemic stroke (4.1% vs 4.2%, adjusted OR 0.99, 95% CI 0.96–1.03, p = 0.71), and patients with pulmonary embolism (14.6% vs 14.6%, adjusted OR 1.02, 95% CI 0.92–1.15, p = 0.66). The results remained for 1 year in all the four major cardiovascular emergencies. Conclusions We found no difference in either short-term or long-term mortality between patients admitted on weekends and patients admitted on weekdays in four major cardiovascular emergencies in Taiwan.

Ruptured Abdominal Aortic Aneurysm Associated with Left Colon Gangrene and Neurological Disorders, a Very Rare and Life-Threatening Combination.

Background: We report the management of a very rare combination of two severe surgical emergencies, ruptured aortic aneurysm with gangrene of the left colon. Both events separately present a high mortality rate in ruptured aortic aneurysms with 48.5%. Case report: We present the case of a 59-year-old woman that was admitted to the service of Emergencies at University Hospital Center “Mother Theresa” of Tirana on January 4th of 2013, after being transferred from the Regional Hospital of Durres diagnosed with ruptured aortic aneurysm based on an unclear CT. The patient arrived in a state of profound hypovolemic shock after suffering cardiac arrest and underwent resuscitation at the ICU of Durres Hospital ( no exact information of the anoxic brain time). After a brief volemic compensation in our ICU, the patient was taken to the operating room. Intraoperatively we found an infrarenal r AAA and gangrene of the sigmoid and left colon. Resection and reconstruction by the interposition of a tube graft were performed, followed by a left large hemicolectomy with temporary colostomy realized by the team of general surgeons. Three months later they performed colorectal-anastomosis as a second step operation. Postoperatively the patient had a period of 3 weeks stay in the ICU, mostly due to neurological complications after the ischemic stroke, and on January 29 of 2013, she returned to the Service of Neurology at the Hospital of Durres for further neurological rehabilitation. One year later, in the ambulatory routine check, the patient presented full recovery from surgery and a complete central and peripheral neurological rehabilitation. Conclusions: Ruptured aortic aneurysm with gangrene of the left colon is a very rare and severe combination caused by the hypoperfusion of the inferior mesenteric artery in the presence of hypovolemic shock and insufficient collateral circulation. The strategy of treatment includes fast diagnosis, short hypotensive resuscitation, cell-saving and autotransfusion, and the simplest possible surgical reconstruction for both emergencies.

Mortality of Major Cardiovascular Emergencies among Patients Admitted to Hospitals on Weekends as Compared with Weekdays in Taiwan

Background/Objectives: To explore the weekend effect in four major cardiovascular emergenciesDesign: A retrospective cohort studySetting: Taiwan National Health Insurance (NHI) claims database, 2005~2015Participants: We extracted 3,811 incident cases of ruptured aortic aneurysm, 184,769 incident cases of acute myocardial infarction, 492,127 incident cases of ischemic stroke, and 15,033 incident cases of pulmonary embolism from 9,529,049 patients having at least one record of hospitalization in the NHI database within 2006~2014.Exposures: Admission on weekends or weekdaysMain outcomes and measures: In-hospital mortality and one-year mortality obtained from the Taiwan National Death RegistryResults: We found no difference in in-hospital mortality between weekend group and weekday group in patients with ruptured aortic aneurysm (45.4% vs 45.3%, adjusted odds ratio [OR] 1.01, 95% confidence interval [CI] 0.87-1.17, p=0.93), patients with acute myocardial infarction (15.8% vs 16.2%, adjusted OR 0.98, 95% CI 0.95-1.00, p=0.10), patients with ischemic stroke (4.1% vs 4.2%, adjusted OR 0.99, 95% CI 0.96-1.03, p=0.71), and patients with pulmonary embolism (14.6% vs 14.6%, adjusted OR 1.02, 95% CI 0.92-1.15, p=0.66). The results persisted for one year in all the four major cardiovascular emergencies. Conclusions: We found no difference in either short-term or long-term mortality between patients admitted on weekends and patients admitted on weekdays in four major cardiovascular emergencies.

Palliative Care in Ruptured Aortic Aneurysm in the United States: A Retrospective Analysis of Nationwide Inpatient Sample Database

We assessed the trend of palliative care (PC) referrals and its effect on hospitalization cost and length of stay (LOS) in ruptured aortic aneurysm (rAA). The Nationwide Inpatient Sample from 2005 to 2014 was used to identify admissions with age ≥50 and rAA. A total of 54 134 rAA admissions were identified and 5019 (9.3%) had PC referrals. During the study period, PC referral rate increased from 0.97% to 15.3% ( P trend < .0001). Length of stay (1.7 vs 2.8 days, adjusted mean ratio [aMR] = 0.62, 95% confidence interval [CI]: 0.58-0.66), and cost (US$7778 vs US$13 575, aMR = 0.57, 95% CI: 0.52-0.63) were significantly lower in rAA admissions that did not undergo interventions. In the percutaneous repair group, LOS was similar but the cost was higher (US$61 759 vs US$52 260, aMR = 1.18, 95% CI: 1.05-1.30), whereas in surgical repair group, LOS was shorter (4.6 vs 5.9 days, aMR = 0.77, 95% CI: 0.73-0.82) but the cost was higher (US$59 755 vs US$52 523, aMR = 1.14, 95% CI: 1.02-1.28). Palliative care could shorten LOS and save hospitalization cost in rAA admissions not a candidate for repair. Further studies are required to investigate the variable effects of PC on rAA.