Advance Access: Impact of Weekend Presentation on Short-Term Outcomes and Choice of Clipping vs Coiling in Subarachnoid Hemorrhage

The effect of weekend presentation on patient care—or, the “weekend effect”—has received significant attention since publication of a landmark study in 2001, which documented that for 23 of the 100 leading nontraumatic causes of death, there was a higher mortality when admitted on a weekend vs a weekday.1 This study cited weekend staffing shortages, relative inexperience of those working weekends, and less managerial oversight on weekends as possible contributors. Other studies documented that another contributing factor to poor outcomes on weekends may be that patients presenting on a weekend were less likely to receive invasive procedures in a timely manner.2 Poor outcomes on the weekends have been shown in ischemic stroke,3,4 though not universally.5 Given the prevalence of weekend effects in general, as well as the importance of early invasive procedures to reduce mortality in subarachnoid hemorrhage (SAH), it is highly likely that weekend effects would exist in SAH. Yet, SAH mortality did not differ on weekends vs weekdays in the United States in 2004.6 While the absence of a weekend effect would be a welcome finding, we sought to explore whether a larger study might identify a small weekend effect or whether weekend presentations may have subtler effects on SAH outcomes by assessing whether weekend presentation influences mortality, discharge disposition, or the type of treatment received (clipping vs coiling).

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