Abstract WP387: Stroke Mortality In Japan Increases On Weekends Altough Those In Comprehensive Stroke Centers Remain Unchanged. -J-ASPECT Study
Objective Weekend disparities in stroke care were well known. The aim of this study is to examine the association between day of admission and the mortality of Stroke in Japan. Moreover, we examine if comprehensive stroke center (CSC) could overcome the weekend effect.
Methods We analyzed the Nationwide registry of claim data(J-ASPECT study) in 378 certified training institutions of the Japan Neurosurgical Society and/or the Japan Stroke Society, which included patients discharged with a primary diagnosis of cerebral infarction in 2011. The definition of CSC was followed by the article of McKinney et al. (Stroke. 2011;42:2403-2409.)
Results A total of 68,718 patients were admitted with a primary diagnosis of cerebral infarction during the study period while 10,141 patients were admitted to comprehensive stroke centers. As a result, thirty-day mortality was statistically greater in patients admitted on weekends compared to weekdays (9.1% versus 8.3%; P= 0.0004). The age and sex adjusted risk of death at 30 days which derived from multivariate logistic regression were also significantly greater for weekend admission (odds ratio, OR= 1.11; 95% CI, 1.04 to 1.18). This association was robust using hierarchical logistic regression which adjusted for institute difference. (OR= 1.06, 95% CI, 1.01 to 1.12) .The mortality of patients in hospitals with stroke care units showed no difference between weekends and weekdays (p=0.398) while the difference was significant for patients, not in a stroke care unit (p=0.046).Furthermore, there was no significant difference in 30-day mortality for patients admitted to CSCs between weekends and weekdays (p=0.418) while patients who were not admitted to CSCs showed the significant mortality difference between weekends and weekdays (p=0.041). The risk of mortality was 2% decreased with the satisfaction of every one criterion for comprehensive stroke care unit. (OR=0.98, 95% CI 0.97 to 0.99) adjusted for weekend effect.
Conclusions Patients with stroke admitted on weekends in Japan had a significantly higher risk of death than weekdays within 30 days. There was no significant weekend difference of stroke mortality at hospitals with stroke care units and comprehensive stroke centers.
- © 2012 by American Heart Association, Inc.