Skip to main content

Advertisement

Springer Nature Link
Log in

The weekend effect in stroke mortality: evidence from Austrian acute care hospitals

  • Research Article
  • Published:
International Journal of Health Economics and Management Aims and scope Submit manuscript

Abstract

Many studies provide evidence for the so-called weekend effect by demonstrating that patients admitted to hospital during weekends show less favourable outcomes such as increased mortality, compared with similar patients admitted during weekdays. The underlying causes for this phenomenon are still discussed controversially. We analysed factors influencing weekend effects in inpatient care for acute stroke in Austria. The study analysed secondary datasets from all 130 public acute care hospitals in Austria between 2010 and 2014 (Austrian DRG Data). The study cohort included 86,399 patient cases admitted with acute ischaemic stroke. By applying multivariate regression analysis, we tested whether patient, treatment or hospital characteristics drove in-hospital mortality on weekends and national holidays. We found that the risk to die after an admission at weekend was significantly higher compared to weekdays, while the number of admissions following stroke was significantly lower. Adjustment for patient, treatment and hospital characteristics substantially reduced the weekend effect in mortality but did not eliminate it. We conclude that the observed weekend effect could be explained either by lower quality of health care or higher severity of stroke admissions at the weekend. In depth analyses supported the hypothesis of higher stroke severity in weekend patients as seen in other studies. While DRG data is useful to analyse stroke treatment and outcomes, adjustment for case mix and severity is essential.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Source Austrian DRG-Data 2015; own calculations

Fig. 2

Source Austrian DRG-Data 2010–2014; own calculations

Fig. 3

Source Austrian DRG-Data 2010–2014; own calculations

Fig. 4

Source Austrian Stroke Unit Registry

Similar content being viewed by others

Notes

  1. Data on the time that elapses between initial stroke and recurrence are sparse. An Asian study reported an average time interval between first ever and recurrent ischemic stroke of 58,75 months (Zhu et al., 2016). Another German study shows a mean time interval of 697 days (Stahmeyer et al., 2019). We see higher frequencies of patients following the assumed initial stroke for a time period of about 6 months with very short stays or ambulatory care in the dataset. These stays are usually coded as acute stroke due to the absence of a code for follow up care after stroke.

  2. Note, this data cannot be matched on an individual basis to the DRG data set.

References

  • Angerer, S., Buttinger, K., & Stummer, H. (2019). The weekend effect revisited: Evidence from the Upper Austrian stroke registry. The European Journal of Health Economics : HEPAC : Health Economics in Prevention and Care, 20(5), 729–737. https://doi.org/10.1007/s10198-019-01035-4

    Article  PubMed  Google Scholar 

  • Arulprakash, N., & Umaiorubahan, M. (2018). Causes of delayed arrival with acute ischemic stroke beyond the window period of thrombolysis. Journal of Family Medicine and Primary Care, 7(6), 1248–1252. https://doi.org/10.4103/jfmpc.jfmpc_122_18

    Article  PubMed  PubMed Central  Google Scholar 

  • Becker, D. J. (2007). Do hospitals provide lower quality care on weekends? Health Services Research, 42(4), 1589–1612. https://doi.org/10.1111/j.1475-6773.2006.00663.x

    Article  PubMed  PubMed Central  Google Scholar 

  • Bell, C. M., & Redelmeier, D. A. (2001). Mortality among patients admitted to hospitals on weekends as compared with weekdays. The New England Journal of Medicine, 345(9), 663–668. https://doi.org/10.1056/NEJMsa003376

    Article  CAS  PubMed  Google Scholar 

  • Bray, B. D., Ayis, S., Campbell, J., Cloud, G. C., James, M., Hoffman, A., Tyrrell, P. J., Wolfe, C. D., & Rudd, A. G. (2014). Associations between stroke mortality and weekend working by stroke specialist physicians and registered nurses: Prospective multicentre cohort study. PLoS Medicine, 11(8), e1001705. https://doi.org/10.1371/journal.pmed.1001705

    Article  PubMed  PubMed Central  Google Scholar 

  • Bray, B. D., Cloud, G. C., James, M. A., Hemingway, H., Paley, L., Stewart, K., Tyrrell, P. J., Wolfe, C. D., & Rudd, A. G. (2016). Weekly variation in health-care quality by day and time of admission: A nationwide, registry-based, prospective cohort study of acute stroke care. Lancet (london, England), 388(10040), 170–177. https://doi.org/10.1016/s0140-6736(16)30443-3

    Article  Google Scholar 

  • Bray, B. D., & Steventon, A. (2017). What have we learnt after 15 years of research into the “weekend effect”? BMJ Quality & Safety, 26(8), 607–610. https://doi.org/10.1136/bmjqs-2016-005793

    Article  Google Scholar 

  • Charlson, M. E., Pompei, P., Ales, K. L., & MacKenzie, C. R. (1987). A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. Journal of Chronic Diseases, 40(5), 373–383.

    Article  CAS  Google Scholar 

  • Clarke, J., Davidson, M. M., Ferris, J. A. J., Gardner, P. S., Gillie, I. M. S., Hogg, M., Longstaff, L., Mantle, D., Ranasinghe, H., Riley, P., Robinson, M. C., Sanderson, A. Y., Scott, D. J., Scott, W. A., Sims, D. G., Warnasuriya, N. D., Webb, J. K. G., & Wilson, D. L. (1977). Newcastle survey of deaths in early childhood 1974/76, with special reference to sudden unexpected deaths. Working party for early childhood deaths in Newcastle. Archives of Disease in Childhood, 52(11), 828–835.

    Article  Google Scholar 

  • Eurostat (2016). RAMON - Reference And Management Of Nomenclatures, Degree of Urbanisation (DEGURBA) - Local Administrative Units. In. European Commission, Brussels.

  • Ferro, J.M., Bousser, M.G., Canhao, P., Coutinho, J.M., Crassard, I., Dentali, F., di Minno, M., Maino, A., Martinelli, I., Masuhr, F., Aguiar de Sousa, D. (2017). European Stroke Organization guideline for the diagnosis and treatment of cerebral venous thrombosis - endorsed by the European Academy of Neurology. 24(10), 1203–1213. doi:https://doi.org/10.1111/ene.13381

  • Freemantle, N., Richardson, M., Wood, J., Ray, D., Khosla, S., Shahian, D., Roche, W. R., Stephens, I., Keogh, B., & Pagano, D. (2012). Weekend hospitalization and additional risk of death: An analysis of inpatient data. Journal of the Royal Society of Medicine, 105(2), 74–84. https://doi.org/10.1258/jrsm.2012.120009

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Gattringer, T., Ferrari, J., Knoflach, M., Seyfang, L., Horner, S., Niederkorn, K., Culea, V., Beitzke, M., Lang, W., Enzinger, C., & Fazekas, F. (2014). Sex-related differences of acute stroke unit care: Results from the Austrian stroke unit registry. Stroke, 45(6), 1632–1638. https://doi.org/10.1161/STROKEAHA.114.004897

    Article  PubMed  Google Scholar 

  • Geissler, A., Scheller-Kreinsen, D., Quentin, W., & Busse, R. (2012). DRG systems in Europe. Incentives, purposes and differences in 12 countries. Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz, 55(5), 633–642.

    Article  CAS  Google Scholar 

  • GeoMagis: Shortest distance matrix, road traffic (2016). In. GeoMarketing & GIS Solutions und Services GmbH, St. Pölten.

  • Ghiani, M., Mueller, S., Maywald, U., & Wilke, T. (2021). Hospitalized with stroke at the weekend: Higher cost and risk of early death? International Journal of Stroke. https://doi.org/10.1177/1747493021992597

    Article  PubMed  Google Scholar 

  • Hellevik, O. (2007). Linear versus logistic regression when the dependent variable is a dichotomy. Quality & Quantity, 43(1), 59–74. https://doi.org/10.1007/s11135-007-9077-3

    Article  Google Scholar 

  • Hoh, B. L., Chi, Y. Y., Waters, M. F., Mocco, J., & Barker, F. G., 2nd. (2010). Effect of weekend compared with weekday stroke admission on thrombolytic use, in-hospital mortality, discharge disposition, hospital charges, and length of stay in the Nationwide Inpatient Sample Database, 2002 to 2007. Stroke, 41(10), 2323–2328. https://doi.org/10.1161/strokeaha.110.591081

    Article  PubMed  Google Scholar 

  • Hsieh, C. Y., Lin, H. J., Chen, C. H., Li, C. Y., Chiu, M. J., & Sung, S. F. (2016). “Weekend effect” on stroke mortality revisited: Application of a claims-based stroke severity index in a population-based cohort study. Medicine, 95(25), e4046. https://doi.org/10.1097/MD.0000000000004046

    Article  PubMed  PubMed Central  Google Scholar 

  • Joynt, K. E., Harris, Y., Orav, E. J., & Jha, A. K. (2011). Quality of care and patient outcomes in critical access rural hospitals. The Journal of the American Medical Association, 306(1), 45–52. https://doi.org/10.1001/jama.2011.902

    Article  CAS  PubMed  Google Scholar 

  • KAKuG: Bundesgesetz über Krankenanstalten und Kuranstalten (1957) In, vol. BGBl Nr. 1/1957. Wien.

  • Kelly-Hayes, M., Wolf, P. A., Kase, C. S., Brand, F. N., McGuirk, J. M., & D’Agostino, R. B. (1995). Temporal patterns of stroke onset. The Framingham Study. Stroke, 26(8), 1343–1347. https://doi.org/10.1161/01.str.26.8.1343

    Article  CAS  PubMed  Google Scholar 

  • Lasserson, D. S., Chandratheva, A., Giles, M. F., Mant, D., & Rothwell, P. M. (2008). Influence of general practice opening hours on delay in seeking medical attention after transient ischaemic attack (TIA) and minor stroke: Prospective population based study. British Medical Journal, 337, a1569. https://doi.org/10.1136/bmj.a1569

    Article  PubMed  PubMed Central  Google Scholar 

  • McKinney, J. S., Deng, Y., Kasner, S. E., & Kostis, J. B. (2011). Comprehensive stroke centers overcome the weekend versus weekday gap in stroke treatment and mortality. Stroke, 42(9), 2403–2409. https://doi.org/10.1161/strokeaha.110.612317

    Article  PubMed  Google Scholar 

  • Meacock, R., Doran, T., & Sutton, M. (2015). What are the costs and benefits of providing comprehensive seven-day services for emergency hospital admissions? Health Economics, 24(8), 907–912. https://doi.org/10.1002/hec.3207

    Article  PubMed  Google Scholar 

  • Neuraz, A., Guerin, C., Payet, C., Polazzi, S., Aubrun, F., Dailler, F., Lehot, J. J., Piriou, V., Neidecker, J., Rimmele, T., Schott, A. M., & Duclos, A. (2015). Patient mortality is associated with staff resources and workload in the ICU: A multicenter observational study. Critical Care Medicine, 43(8), 1587–1594. https://doi.org/10.1097/CCM.0000000000001015

    Article  PubMed  Google Scholar 

  • Ozdemir, B. A., Sinha, S., Karthikesalingam, A., Poloniecki, J. D., Pearse, R. M., Grocott, M. P., Thompson, M. M., & Holt, P. J. (2016). Mortality of emergency general surgical patients and associations with hospital structures and processes. British Journal of Anaesthesia, 116(1), 54–62. https://doi.org/10.1093/bja/aev372

    Article  CAS  PubMed  Google Scholar 

  • Powers, W. J., Rabinstein, A. A., Ackerson, T., Adeoye, O. M., Bambakidis, N. C., Becker, K., Biller, J., Brown, M., Demaerschalk, B. M., Hoh, B., Jauch, E. C., Kidwell, C. S., Leslie-Mazwi, T. M., Ovbiagele, B., Scott, P. A., Sheth, K. N., Southerland, A. M., Summers, D. V., & Tirschwell, D. L. (2018). 2018 guidelines for the early management of patients with acute ischemic stroke: A guideline for healthcare professionals from the American heart association/american stroke association. Stroke, 49(3), e46–e110. https://doi.org/10.1161/str.0000000000000158

    Article  PubMed  Google Scholar 

  • Roberts, S. E., Thorne, K., Akbari, A., Samuel, D. G., & Williams, J. G. (2015). Mortality following stroke, the weekend effect and related factors: Record linkage study. PLoS ONE, 10(6), e0131836. https://doi.org/10.1371/journal.pone.0131836

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Rost, N. S., Bottle, A., Lee, J. M., Randall, M., Middleton, S., Shaw, L., Thijs, V., Rinkel Gabriel, J. E., & Hemmen Thomas, M. (2016). Stroke severity is a crucial predictor of outcome: An international prospective validation study. Journal of the American Heart Association. https://doi.org/10.1161/JAHA.115.002433

    Article  PubMed  PubMed Central  Google Scholar 

  • Saposnik, G. et al. (2007). Hospital volume and stroke outcome: Does it matter? Neurology 69(1).

  • Saposnik, G., Baibergenova, A., Bayer, N., & Hachinski, V. (2007). Weekends: A dangerous time for having a stroke? Stroke, 38(4), 1211–1215. https://doi.org/10.1161/01.STR.0000259622.78616.ea

    Article  PubMed  Google Scholar 

  • Stahmeyer, J. T., Stubenrauch, S., Geyer, S., Weissenborn, K., & Eberhard, S. (2019). The frequency and timing of recurrent stroke: An analysis of routine health insurance data. Deutsches Ärzteblatt International, 116(42), 711–717. https://doi.org/10.3238/arztebl.2019.0711

    Article  PubMed  Google Scholar 

  • Sung, S. F., Hsieh, C. Y., Kao Yang, Y. H., Lin, H. J., Chen, C. H., Chen, Y. W., & Hu, Y. H. (2015). Developing a stroke severity index based on administrative data was feasible using data mining techniques. Journal of Clinical Epidemiology, 68(11), 1292–1300. https://doi.org/10.1016/j.jclinepi.2015.01.009

    Article  PubMed  Google Scholar 

  • Svendsen Marie, L., Ehlers Lars, H., Ingeman, A., & Johnsen Søren, P. (2012). Higher stroke unit volume associated with improved quality of early stroke care and reduced length of stay. Stroke, 43(11), 3041–3045. https://doi.org/10.1161/STROKEAHA.111.645184

    Article  PubMed  Google Scholar 

  • Walker, A. S., Mason, A., Quan, T. P., Fawcett, N. J., Watkinson, P., Llewelyn, M., Stoesser, N., Finney, J., Davies, J., Wyllie, D. H., Crook, D. W., & Peto, T. E. A. (2017). Mortality risks associated with emergency admissions during weekends and public holidays: An analysis of electronic health records. Lancet (london, England), 390(10089), 62–72. https://doi.org/10.1016/s0140-6736(17)30782-1

    Article  Google Scholar 

  • Zajic, P., Bauer, P., Rhodes, A., Moreno, R., Fellinger, T., Metnitz, B., Stavropoulou, F., Posch, M., & Metnitz, P. G. H. (2017). Weekends affect mortality risk and chance of discharge in critically ill patients: A retrospective study in the Austrian registry for intensive care. Critical Care (london, England), 21(1), 223. https://doi.org/10.1186/s13054-017-1812-0

    Article  Google Scholar 

  • Zhu, R., Xu, K., Shi, J., Yan, Q. (2016). Time interval between first ever and recurrent stroke in a population hospitalized for second stroke: A retrospective study. Neurology Asia 21(3).

Download references

Author information

Authors and Affiliations

  1. Department for Health Economics & Health Systems Analysis, Austrian Public Health Institute, Stubenring 6, 1010, Vienna, Austria

    Florian Bachner & Martin Zuba

  2. Department of Economics, Johannes Kepler University of Linz, Altenberger Straße 69, 4040, Linz, Austria

    Florian Bachner

Authors
  1. Florian Bachner
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Martin Zuba
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Florian Bachner or Martin Zuba.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Appendix

Appendix

See Tables

Table 3 Results of multilevel linear probability regression analysis with 30-day in-hospital mortality after Stroke as binary dependent variable.
Full size table

3,

Table 4 Results of multilevel logit regression analysis with 30-day in-hospital mortality after Stroke as binary dependent variable.
Full size table

4,

Table 5 Results of multilevel regression analysis with 30-day in-hospital mortality, admission to stroke unit and average length of stay after stroke.
Full size table

5,

Table 6 Comparative data on mortality rates and average length of stay by weekday.
Full size table

6

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bachner, F., Zuba, M. The weekend effect in stroke mortality: evidence from Austrian acute care hospitals. Int J Health Econ Manag. 22, 205–236 (2022). https://doi.org/10.1007/s10754-021-09317-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10754-021-09317-2

Keywords

Search

Navigation

pFad - Phonifier reborn

Pfad - The Proxy pFad of © 2024 Garber Painting. All rights reserved.

Note: This service is not intended for secure transactions such as banking, social media, email, or purchasing. Use at your own risk. We assume no liability whatsoever for broken pages.


Alternative Proxies:

Alternative Proxy

pFad Proxy

pFad v3 Proxy

pFad v4 Proxy