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.
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Kothari AN, Zapf MAC, Blackwell RH, Chang V, Mi Z, Gupta GN, et al. (2015) Components Of Hospital Perioperative Infrastructure Can Overcome The Weekend Effect In Urgent General Surgery Procedures.
Article info
Publication history
Published online: May 23, 2015
Accepted:
February 10,
2015
Identification
Copyright
© 2015 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
