1. RESULTS: RATE OF SURGICAL EVACUATION & IN- HOSPITAL MORTALITY IN tSDH RESULTS The Effect of Weekend Admission on the Treatment and Short-Term Outcomes of Traumatic Subdural Hematoma Kavelin Rumalla 1, Adithi Y Reddy 1, Manoj K Mittal, MD 2 1 University of Missouri-Kansas City School of Medicine, Kansas City MO; 2 University of Kansas Medical Center, Department of Neurology, Kansas City, KS INTRODUCTION ❖ Previous studies have reported poorer outcomes in patients admitted for acute conditions on weekends due to decreases in staffing and delays in care. 1-5 ❖ Traumatic subdural hematoma (tSDH) is a potentially life-threatening emergency that can result in severe morbidity and mortality if left untreated. 6-8 ❖ Here, we investigated the effect of weekend admission on the surgical management and in-hospital outcomes of tSDH using the Nationwide Inpatient Sample (NIS). ❖ We queried the NIS (2004-2011), the largest inpatient database in the United States, using ICD-9-CM codes to identify all patients (age ≥ 18) emergently admitted with a primary diagnosis of tSDH. ❖ A weekend admission in the NIS was defined as an admission only on a Saturday or Sunday. ❖ Parameters of interest included pre-admission factors such as age, gender, race, insurance status, preexisting comorbidity and concomitant secondary diagnoses (ischemic stroke, subarachnoid hemorrhage, intracerebral hemorrhage, brain herniation, cerebral edema, and coma). ❖ Surgical evacuation for tSDH was identified by ICD-9-CM procedure code 01.31. ❖ Patient characteristics and short-term outcomes were compared between weekend and weekday cohorts using the Pearson-chi square test for categorical variables and the independent samples t-test for continuous variables. ❖ The primary outcomes of interest were in-hospital mortality, surgical intervention, and time to surgical intervention. Secondary outcomes included length of stay and total charges. ❖ Binary logistic regression analysis was used to evaluate the effect of weekend admissions on mortality and surgical intervention. ❖ A total of 114,632 patients were admitted with a primary diagnosis of traumatic SDH and 31,150 (27.2%) were admitted on weekends. ❖ Age, gender, race, insurance status, and preexisting comorbidity differed significantly between the weekend and weekday cohorts ❖ After adjustment for confounders that differed between the weekend and weekday cohorts, the likelihood of in-hospital mortality was 29% higher (P<0.0001) in patients admitted on a weekend (OR: 1.29, 95% CI: 1.14-1.46). ❖ In additional multivariate models adjusted for potential confounders, the likelihood of a patient receiving surgical evacuation was decreased by 15% (P<0.0001) on weekends (OR: 0.87, 95% CI: 0.79-0.96). ❖ Patients admitted on weekends were 59% (P<0.0001) less likely to receive surgery on the day that they were admitted. (OR: 0.63, 95% CI: 0.54-0.72). ❖ Patients hospitalized for tSDH on weekends suffered worse in-hospital outcomes, including extended hospital stays, increased hospital costs, and greater likelihood of in-hospital mortality. ❖ Our results suggest that these poor outcomes could be the result of the diminished availability of staff to perform surgical life-saving procedures. CONCLUSION RESULTS METHODS 1.Bell CM, Redelmeier DA: Mortality among Patients Admitted to Hospitals on Weekends as Compared with Weekdays. N Engl J Med 345:663–668, 2001 2.Busl KM, Prabhakaran S: Predictors of mortality in nontraumatic subdural hematoma. J Neurosurg 119:1296–1301, 2013 3.Deshmukh A, Pant S, Kumar G, Bursac Z, Paydak H, Mehta JL: Comparison of outcomes of weekend versus weekday admissions for atrial fibrillation. Am J Cardiol 110:208–211, 2012 4.Gallerani M, Imberti D, Bossone E, Eagle KA, Manfredini R: Higher mortality in patients hospitalized for acute aortic rupture or dissection during weekends. J Vasc Surg 55:1247–1254, 2012 5.Laks MP, Rotblat M: Mortality among patients admitted to hospitals on weekends as compared with weekdays. N Engl J Med 346:1500–1; author reply 1500–1501, 2002 6.Kalanithi P, Schubert RD, Lad SP, Harris OA, Boakye M: Hospital costs, incidence, and inhospital mortality rates of traumatic subdural hematoma in the United States. J Neurosurg 115:1013–1018, 2011 7.Karibe H, Hayashi T, Hirano T, Kameyama M, Nakagawa A, Tominaga T: Surgical management of traumatic acute subdural hematoma in adults: a review. Neurol Med Chir (Tokyo) 54:887–894, 2014 8.Wilberger JEJ, Harris M, Diamond DL: Acute subdural hematoma: morbidity and mortality related to timing of operative intervention. J Trauma 30:733–736, 199 REFERENCES ❖ The NIS does not include information regarding timing of admission, diagnoses, or procedures, so we could not include Friday night admissions in our weekend cohort. ❖ The NIS database lacks information for a number of clinical factors specific to tSDH, including onset of symptoms, severity of tSDH based on clinical/radiological evidence, or exact mechanism of injury. ❖ The database does not track post-discharge outcomes or long-term functional status. LIMITATIONS