gms | German Medical Science

Objective: The “weekend effect” describes that emergency hospital admissions and/or procedures performed at night and on weekends may be associated with a worse clinical outcome when compared to admissions during regular working hours. This study evaluates, whether admission of patients with subarachnoid haemorrhage (SAH) out of regular working hours and microsurgical clipping at nighttime are associated with a worse patient outcome.

Methods: Consecutive patients that underwent microsurgical clipping of an acutely ruptured aneurysm at a single institution between 2010 and 2019 were retrospectively reviewed. 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 parameters: baseline patient and aneurysm characteristics, timing and duration of surgery, procedural complications, clinical outcome and angiographic results.

Results: Out of 157 included patients, 53 (34%) were admitted during regular working hours and 104 (66%) during on-call duty. Clipping was performed during daytime in 109 cases (69%) and at nighttime in 48 (31%). Baseline patient and aneurysm characteristics were comparable between the subgroups. Admission during on-call duty did not affect the admission-to-surgery time (8±7 h vs. 10±6 h, p=0.3), overall cerebral infarction (43% vs. 49%, p=0.5), mortality (12% vs. 17%, p=0.3), 6-month favourable outcome (47% vs. 59%, p=0.2) and complete aneurysm occlusion rates (72% vs. 76%, p=0.7). In the univariate analysis, microsurgical clipping at nighttime was associated with higher odds of unfavourable outcome at discharge (OR: 2.3, 95%CI: 1.0 – 5.1, p=0.039). However, this difference did not remain significant after multivariable adjustment (OR: 2.1, 95%CI: 0.7 – 6.2, p=0.2). The operation time (261 ± 70 min vs. 274 ± 84 min, p=0.3), procedure-related cerebral infarction (23% vs. 21%, p=0.8), and complete aneurysm occlusion rates (70% vs. 74%, p=0.9) were comparable between nighttime and daytime surgery.

Conclusion: Admission out of regular working hours and clipping at nighttime were not independently associated with a poor clinical outcome. The adherence to standardized treatment protocols might mitigate the “weekend effect” in clinical practice, as suggested previously for ischemic stroke.