{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T20:18:33Z","timestamp":1787689113572,"version":"build-2784847793"},"reference-count":25,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"12","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Stroke"],"published-print":{"date-parts":[[2018,12]]},"abstract":"<jats:sec>\n            <jats:title>Background and Purpose\u2014<\/jats:title>\n            <jats:p>Patients undergoing surgery on the weekend may experience worse outcomes, but this weekend effect has not been studied in carotid endarterectomy (CEA).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods\u2014<\/jats:title>\n            <jats:p>We identified patients undergoing isolated CEA in the Vascular Quality Initiative between 2003 and 2018. Our primary outcome was in-hospital stroke or perioperative death (stroke\/death), stratified by symptom status. For asymptomatic patients, we also compared rates of the Centers for Medicare and Medicaid Services quality metric prolonged length of stay (&gt;2 days or failed discharge home). We calculated propensity scores and used multilevel, inverse probability weighted logistic regression clustering at the hospital level.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results\u2014<\/jats:title>\n            <jats:p>\n              There were 86\u2009123 repairs during the study period, 53% asymptomatic lesions and 47% symptomatic. Only 0.7% of asymptomatic patients underwent CEA on the weekend, compared with 3.1% of symptomatic patients. Patients undergoing weekend repairs were more often white, with lower rates of most comorbidities. In asymptomatic patients, weekend operations were associated significantly higher odds of stroke\/death (odds ratio [OR], 2.3 [1.1\u20134.8];\n              <jats:italic>P<\/jats:italic>\n              =0.02), and prolonged length of stay (OR, 3.6 [2.7\u20134.7];\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001). In symptomatic patients, weekend operations were associated with significantly higher adjusted odds of stroke\/death (OR, 1.7 [1.2\u20132.4];\n              <jats:italic>P<\/jats:italic>\n              =0.007) and longer postoperative length of stay (3.3 days versus 2.0 days,\n              <jats:italic>P<\/jats:italic>\n              =0.002). However, the difference in stroke\/death was driven by patients presenting with stroke (OR, 2.2 [1.5\u20132.3];\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001), rather than those presenting with transient ischemic attack (OR, 1.2 [0.6\u20132.1];\n              <jats:italic>P<\/jats:italic>\n              =0.56).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions\u2014<\/jats:title>\n            <jats:p>We found evidence of a significant weekend effect in CEA, as weekend operations in asymptomatic patients and patients who presented with stroke were associated with higher rates of stroke\/death and prolonged length of stay. However, there was no evidence of such an effect in patients with transient ischemic attack. These data suggest that weekend CEA should be avoided except in the case of expedited revascularization after transient ischemic attack.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/strokeaha.118.022305","type":"journal-article","created":{"date-parts":[[2018,12,26]],"date-time":"2018-12-26T15:07:11Z","timestamp":1545836831000},"page":"2945-2952","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":20,"title":["Weekend Effect in Carotid Endarterectomy"],"prefix":"10.1161","volume":"49","author":[{"given":"Thomas F.X.","family":"O\u2019Donnell","sequence":"first","affiliation":[{"name":"From the Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, MA (T.F.X.O., M.L.S., P.L., C.L., N.J.S., M.C.W.)"},{"name":"Department of Surgery, Massachusetts General Hospital, Boston (T.F.X.O.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc L.","family":"Schermerhorn","sequence":"additional","affiliation":[{"name":"From the Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, MA (T.F.X.O., M.L.S., P.L., C.L., N.J.S., M.C.W.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patric","family":"Liang","sequence":"additional","affiliation":[{"name":"From the Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, MA (T.F.X.O., M.L.S., P.L., C.L., N.J.S., M.C.W.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chun","family":"Li","sequence":"additional","affiliation":[{"name":"From the Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, MA (T.F.X.O., M.L.S., P.L., C.L., N.J.S., M.C.W.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas J.","family":"Swerdlow","sequence":"additional","affiliation":[{"name":"From the Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, MA (T.F.X.O., M.L.S., P.L., C.L., N.J.S., M.C.W.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grace J.","family":"Wang","sequence":"additional","affiliation":[{"name":"Division of Vascular and Endovascular Surgery, University of Pennsylvania, Philadelphia (G.J.W.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristina A.","family":"Giles","sequence":"additional","affiliation":[{"name":"Division of Vascular and Endovascular Surgery, University of Florida Health, Gainesville (K.A.G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark C.","family":"Wyers","sequence":"additional","affiliation":[{"name":"From the Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, MA (T.F.X.O., M.L.S., P.L., C.L., N.J.S., M.C.W.)"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jss.2017.05.071"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0000000000000532"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0000000000000137"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2004.02.035"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1177\/1355819616649630"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.12788\/jhm.2815"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.160511"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2015-010482"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1002\/lt.23395"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2014.08.091"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0b013e3181fb84bc"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.0000259622.78616.ea"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jstrokecerebrovasdis.2014.06.006"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.108.546572"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","unstructured":"O\u2019Donnell TFX Li C Swerdlow NJ Liang P Pothof AB Patel VI et al. The weekend effect in AAA repair [published online April 18 2018]. Ann Surg. doi: 10.1097\/SLA.0000000000002773. https:\/\/journals.lww.com\/annalsofsurgery\/Abstract\/publishahead\/The_Weekend_Effect_in_AAA_Repair.95652.aspx.","DOI":"10.1097\/SLA.0000000000002773"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.avsg.2017.09.028"},{"key":"e_1_3_3_18_2","first-page":"77008","article-title":"Medicare Program; Merit-Based Incentive Payment System (MIPS) and Alternative Payment Model (APM) incentive under the physician fee schedule, and criteria for physician-focused payment models. Final rule with comment period.","volume":"81","author":"Centers for Medicare & Medicaid Services (CMS), HHS","year":"2016","unstructured":"Centers for Medicare & Medicaid Services (CMS), HHS. Medicare Program; Merit-Based Incentive Payment System (MIPS) and Alternative Payment Model (APM) incentive under the physician fee schedule, and criteria for physician-focused payment models. 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