Faculty Collaboration Database

The "weekend effect" in urgent general operative procedures. Surgery 2015 Aug;158(2):508-14

Date

05/28/2015

Pubmed ID

26013983

Pubmed Central ID

PMC5226376

DOI

10.1016/j.surg.2015.02.024

Scopus ID

2-s2.0-84937513922 (requires institutional sign-in at Scopus site)   67 Citations

Abstract

BACKGROUND: There is growing concern that the quality of inpatient care may differ on weekends versus weekdays. We assessed the "weekend effect" in common urgent general operative procedures.

METHODS: The Healthcare Cost and Utilization Project Florida State Inpatient Database (2007-2010) was queried to identify inpatient stays with urgent or emergent admissions and surgery on the same day. Included were patients undergoing appendectomy, cholecystectomy for acute cholecystitis, and hernia repair for obstructed/gangrenous hernia. Outcomes included duration of stay, inpatient mortality, hospital-adjusted charges, and postoperative complications. Controlling for hospital and patient characteristics and type of surgery, we used multilevel mixed-effects regression modeling to examine associations between patient outcomes and admissions day (weekend vs weekday).

RESULTS: A total of 80,861 same-day surgeries were identified, of which 19,078 (23.6%) occurred during the weekend. Patients operated on during the weekend had greater charges by $185 (P < .05), rates of wound complications (odds ratio [OR] 1.29, 95% confidence interval [95% CI] 1.05-1.58; P < .05), and urinary tract infection (OR 1.39, 95% CI 1.05-1.85; P < .05). Patients undergoing appendectomy had greater rates of transfusion (OR 1.43, 95% CI 1.09-1.87; P = .01), wound complications (OR 1.32, 95% CI 1.04-1.68; P < .05), urinary tract infection (OR 1.76, 95% CI 1.17-2.67; P < .01), and pneumonia (OR 1.41, 95% CI 1.05-1.88; P < .05). Patients undergoing cholecystectomy had a greater duration of stay (P = .001) and greater charges (P = .003).

CONCLUSION: Patients undergoing weekend surgery for common, urgent general operations are at risk for increased postoperative complications, duration of stay, and hospital charges. Because the cause of the "weekend effect" is still unknown, future studies should focus on elucidating the characteristics that may overcome this disparity.

Author List

Zapf MA, Kothari AN, Markossian T, Gupta GN, Blackwell RH, Wai PY, Weber CE, Driver J, Kuo PC

Author

Anai N. Kothari MD Assistant Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
After-Hours Care
Aged
Aged, 80 and over
Databases, Factual
Emergencies
Female
Florida
General Surgery
Hospital Charges
Hospital Mortality
Hospitalization
Humans
Length of Stay
Logistic Models
Male
Middle Aged
Odds Ratio
Postoperative Complications
Surgical Procedures, Operative