The weekend effect revisited: evidence from the Upper Austrian stroke registry

Area of Science:

• Neurology
• Public Health
• Health Services Research

Background:

• The 'weekend effect' on stroke mortality presents conflicting empirical evidence, with some studies indicating higher mortality for weekend admissions and others finding no significant difference.
• Investigating this phenomenon is crucial for understanding potential disparities in stroke care and patient outcomes.

Purpose of the Study:

• To provide robust evidence on the weekend effect concerning stroke mortality using a comprehensive stroke registry from Upper Austria.
• To explore potential reasons behind the observed heterogeneity in findings regarding weekend stroke mortality.

Main Methods:

• Utilized logistic and ordinary least squares regressions with hospital and year-fixed effects.
• Analyzed data from 16 hospitals in Upper Austria between 2007 and 2015, including patients with transient ischemic attack (TIA), cerebral infarction, or hemorrhage.
• Assessed in-hospital mortality, 30-day and 90-day all-cause mortality, length of hospital stay, and process-quality indicators.

Main Results:

• Weekend admissions were approximately 25% lower than weekday admissions.
• Weekend admissions were associated with significantly higher in-hospital mortality.
• After adjusting for case-mix, the association between weekend admissions and mortality became non-significant, suggesting admission heterogeneity rather than quality differences.

Conclusions:

• The higher in-hospital mortality observed for weekend stroke admissions is primarily attributable to differences in patient admission characteristics, not variations in healthcare quality.
• Further research should focus on understanding the factors influencing weekend admission patterns for stroke patients.