A ‘weekend effect’ in operative emergency general surgery - 17/11/19

Doi : 10.1016/j.amjsurg.2019.11.024

Justin S. Hatchimonji ^a,^⁎ , Elinore J. Kaufman ^b, Catherine E. Sharoky ^a, Lucy W. Ma ^c, Daniel N. Holena ^b
^a Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
^b Division of Traumatology, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
^c College of Arts and Sciences, University of Pennsylvania, Philadelphia, PA, USA

^∗Corresponding author. Department of Surgery, University of Pennsylvania School of Medicine, 3400 Spruce St, 4 Maloney, USA.Department of SurgeryUniversity of Pennsylvania School of Medicine3400 Spruce St4 MaloneyUSA

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Sunday 17 November 2019

Abstract

Background

Evidence of a “weekend effect” is limited in emergency general surgery (EGS). We hypothesized that there are increased rates of complications, death, and failure-to-rescue (FTR) in patients undergoing weekend EGS operations.

Methods

National Inpatient Sample (NIS) data, January 2014–September 2015 were used. Operative EGS patients were identified by ICD-9 procedure code and timing to operation. Complications were defined by ICD-9 code. We performed survey-weighted multivariable regression analyses.

Results

Of 438,110 EGS patients, 103,450 underwent weekend operation. There was no association between weekend operation and FTR (OR 1.17; 95%CI 0.95–1.45) or complications (OR 1.04; 95%CI 0.97–1.13). There was a weekend effect on mortality (OR 1.22; 95%CI 1.02–1.46) and an interactive effect between weekend operation and teaching status on complications (teaching OR 1.22; 95%CI 1.15–1.29; interaction OR 1.13; 95%CI 1.03–1.25).

Conclusions

There is evidence for a “weekend effect” on mortality, but not complications or FTR, in this cohort.

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Highlights

•	Weekend operation is associated with mortality in emergency general surgery.
•	Failure-to-rescue and complication rates are not associated with weekend operation.
•	There is an interactive “weekend effect” on complications at teaching hospitals.

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Résumé

Summary: National Inpatient Sample data was examined and revealed that weekend operation is associated with increased mortality in emergency general surgery. Though weekend operation was not independently associated with an increase in complication rate, there was an interactive effect with hospital teaching status.

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Keywords : Metrics, Quality improvement, Failure-to-rescue, Emergency general surgery