Impact of Off-Hour Admission on In-Hospital Outcomes for Patients With Stroke Receiving Reperfusion Therapy in China

Zeyu Liu; Kaixuan Yang; Hongqiu Gu; Minping Wei; Xianjing Feng; Fang Yu; Yang Du; Zixiao Li; Jian Xia

doi:10.1161/STROKEAHA.123.046096

Impact of Off-Hour Admission on In-Hospital Outcomes for Patients With Stroke Receiving Reperfusion Therapy in China

Stroke. 2024 May;55(5):1359-1369. doi: 10.1161/STROKEAHA.123.046096. Epub 2024 Mar 28.

Authors

Zeyu Liu^{1

2

3}, Kaixuan Yang^{4

5}, Hongqiu Gu^{4

5}, Minping Wei^{1

2

3}, Xianjing Feng^{1

2

3}, Fang Yu^{1

2

3}, Yang Du^{1

2

3}, Zixiao Li^{4

5

6}, Jian Xia^{1

2

3}

Affiliations

¹ Department of Neurology, Xiangya Hospital (Z. Liu, M.W., X.F., F.Y., Y.D., J.X.), Central South University, Changsha, Hunan, China.
² Clinical Research Center for Cerebrovascular Disease of Hunan Province (Z. Liu, M.W., X.F., F.Y., Y.D., J.X.), Central South University, Changsha, Hunan, China.
³ National Clinical Research Center for Geriatric Disorders, Xiangya Hospital (Z. Liu, M.W., X.F., F.Y., Y.D., J.X.), Central South University, Changsha, Hunan, China.
⁴ China National Clinical Research Center for Neurological Diseases (K.Y., H.G., Z. Li), Beijing Tiantan Hospital, Capital Medical University, China.
⁵ National Center for Healthcare Quality Management in Neurological Diseases (K.Y., H.G., Z. Li), Beijing Tiantan Hospital, Capital Medical University, China.
⁶ Vascular Neurology, Department of Neurology (Z. Li), Beijing Tiantan Hospital, Capital Medical University, China.

PMID: 38545773
DOI: 10.1161/STROKEAHA.123.046096

Abstract

Background: The structure and staffing of hospitals greatly impact patient outcomes, with frequent changes occurring during nights and weekends. This retrospective cohort study assessed the impact of admission timing on in-hospital management and outcomes for patients with stroke receiving reperfusion therapy in China using data from a nationwide registry.

Methods: Data from patients receiving reperfusion therapy were extracted from the Chinese Stroke Center Alliance. Hospital admission time was categorized according to day/evening versus night and weekday versus weekend. Primary outcomes were in-hospital death or discharge against medical advice, hemorrhage transformation, early neurological deterioration, and major adverse cardiovascular events. Logistic regression was performed to compare in-hospital management performance and outcomes based on admission time categories.

Results: Overall, 42 381 patients received recombinant tissue-type plasminogen activator (r-tPA) therapy, and 5224 underwent endovascular treatment (EVT). Patients admitted during nighttime had a higher probability of receiving r-tPA therapy within 4.5 hours from onset or undergoing EVT within 6 hours from onset compared with those admitted during day/evening hours (adjusted odds ratio, 1.04 [95% CI, 1.01-1.08]; P=0.021; adjusted odds ratio, 1.72 [95% CI, 1.59-1.86]; P<0.001, respectively). However, no significant difference was observed between weekend and weekday admissions for either treatment. No notable differences were noted between weekends and weekdays or nighttime and daytime periods in door-to-needle time for r-tPA or door-to-puncture time for EVT initiation. Furthermore, weekend or nighttime admission did not have a significant effect on the primary outcomes of r-tPA therapy or EVT. Nevertheless, in patients undergoing EVT, a higher incidence of pneumonia was observed among those admitted at night compared with those admitted during day/evening hours (adjusted odds ratio, 1.22 [95% CI, 1.05-1.42]; P=0.011).

Conclusions: Patients admitted at nighttime were more likely to receive r-tPA therapy or EVT within the time window recommended in the guidelines. However, patients receiving EVT admitted at night had an increased risk of pneumonia.

Keywords: hospital mortality; ischemic stroke; pneumonia; reperfusion; workforce.