S. P. Nassoiy1, B. A. Blanco1, E. M. Grindstaff1, Y. Azure1, P. C. Kuo1, A. N. Kothari1 1Loyola University Medical Center,Maywood, IL, USA
Introduction: Temporal disparities of care, including the “weekend effect”, can negatively impact surgical outcomes. Our objective was to determine if patients undergoing elective, weekend surgery were at increased risk for developing adverse postoperative events.
Methods: Patients >18 years old who underwent elective general surgery between 2009 and 2010 in California, Florida, Iowa, New York or Washington were identified using the Health Care and Utilization Project State Inpatient Database. General surgery was defined as procedures of the gastrointestinal, endocrine and integumentary system. The primary outcome was inpatient mortality or major morbidity. Propensity scores were assigned using patient comorbidity and surgical approach. Risk adjustment was performed at the hospital level using multivariable logistic regression.
Results:489,516 patients at 757 hospitals met our inclusion criteria. Of these, 4,391 patients underwent surgery on the weekend at 541 hospitals. 3,683 were propensity matched (1:1) to patients who had weekday surgery and no difference in the primary outcome was observed (2.1% vs. 2.5%, p=0.212). However, significant outcome variation existed amongst hospitals routinely performing elective weekend surgery (top volume decile), with 17.6% having higher than expected event rates, 22.8% with as expected performance, and 59.6% performing better than expected.
Conclusion: Overall, no population-level temporal disparity was identified in patients undergoing elective general surgery on the weekend. Certain centers did have increased incidence of major adverse events on the weekend than during the week. Future studies will be directed at elucidating hospital characteristics that can reduce this disparity in surgical care.