M. A. Zapf1, A. Kothari1, T. Markossian2, G. Gupta1, P. Wai1, J. Driver1, P. Kuo1 1Loyola University Chicago Stritch School Of Medicine,Surgery,Maywood, IL, USA 2Loyola University Chicago Stritch School Of Medicine,Public Health Sciences,Maywood, IL, USA
Introduction: There is growing concern that the quality of inpatient care may differ on weekends vs. weekdays. We aimed to assess the “weekend effect” in common urgent general surgical procedures.
Methods: The Healthcare Cost and Utilization Project Florida State Inpatient Database (2007-2010) was queried to identify inpatient stays with admission from the ER or urgent care center followed by surgery on the same day. Included were patients undergoing appendectomy, cholecystectomy for acute cholecystitis, and inguinal, femoral, ventral, incisional or umbilical hernia repair with diagnosis of obstructed or gangrenous hernia. Outcomes included length of stay (LOS), inpatient mortality, hospital-adjusted charges and complications not present on admission. We assessed patient outcomes using univariate analysis and with multilevel mixed-effects regression modeling that was used to examine the association between patients’ outcomes and admissions day (weekend vs. weekday), controlling for hospital characteristics, patients’ demographic and clinical characteristics, and type of surgery.
Results:A total of 80,861 same day surgeries were identified, of which 19,078 (23.6%) occurred during the weekend. Patient characteristics were similar between groups. Patients operated on during the weekend had greater LOS (3.05 ± 0.033 v 2.98 ± 0.016 p<0.05) and an increase in charges by $185 (p<0.05), both of which were also significant in the multiple regression modeling. Inpatient mortality was similar between groups, however patients undergoing weekend surgeries were more likely to develop wound complications (OR 1.28, 95% CI 1.08-1.52 p<0.05) and pneumonia (OR 1.29, 95% CI 1.10-1.52 p<0.05). When procedures were considered in isolation (table), weekend procedures were associated with distinctive subgroups of inferior outcomes.
Conclusion:Patients undergoing weekend surgery for common urgent general surgical operations are at risk for significantly increased postoperative complications, length of stay and hospital charges. In an age of quality improvement, health systems should consider processes that bolster weekend perioperative care. As the cause of the “weekend effect” is still unknown, future studies should focus on elucidating the institutional characteristics that may overcome this disparity.
Table 1. Shaded boxes: p<0.05 in weekend vs. weekday
