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. 2015 Aug;158(2):508-14.
doi: 10.1016/j.surg.2015.02.024. Epub 2015 May 23.

The "weekend effect" in urgent general operative procedures

Matthew A C Zapf  1 , Anai N Kothari  1 , Talar Markossian  2 , Gopal N Gupta  1 , Robert H Blackwell  1 , Phillip Y Wai  3 , Cynthia E Weber  3 , Joseph Driver  3 , Paul C Kuo  4
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The "weekend effect" in urgent general operative procedures

Matthew A C Zapf et al. Surgery. 2015 Aug.

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.

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Figures

Fig 1
Fig 1
Study design. Included were patients who underwent appendectomy, cholecystectomy for acute cholecystitis, or hernia repair for obstructed/gangrenous hernia who were admitted as urgent or emergent type and received surgery on the same day as admission.
Fig 2
Fig 2
Unadjusted comparison of surgical outcomes between weekend versus weekday surgery. Part (A) depicts duration of stay, (B) depicts charges, and (C) depicts rates of specific complications. Outcome means are depicted with corresponding SE. *P < 0.05
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