WEEKDAY OR WEEKEND HOSPITAL ADMISSION: DOES IT MATTER FOR ACUTE CARE SURGERY?
Hospitals usually reduce staffing levels and services during weekends, which may result in a decrease in the quality of healthcare or the so-called weekend effect. In this study, we aimed to measure the impact and outcome of weekends on two common emergency general surgeries, in terms of the day of operation and admission.
Methods and procedures:
This retrospective cohort study was conducted at a tertiary care hospital between January and December 2016. Surgical procedures included were cholecystectomy and appendectomy. Patient demographic information, co-morbidities, admission date, surgery date, complications, readmission and follow-up details were collected from the electronic medical records.
A total of 539 patient records were included. The median age for weekday admissions was 31 years (IQR: 22, 45), and 32 years (IQR: 23, 49.75) for weekend admissions. The majority of patients were admitted during weekdays (n=391). No significant difference was found in the type of surgery performed between weekday and weekend admissions (p-value=0.384). Surgeries tend to be delayed by a median of one day for weekend admissions compared to weekdays with similar overall length of stay (LOS) for both groups. Weekend admissions were associated with higher complication rates compared with weekday admissions (12.2% vs. 6.1%). Regarding the day of surgery, 444 surgeries were performed during weekdays with 86 surgeries performed during weekends. In terms of post-discharge variables, slightly more weekend admissions had an ED visit (14.2% vs 12.0%) or readmission (4.1% vs 2.0%), but the findings were not statistically significant. The frequency of emergency general surgeries is reduced during the weekends. Patients who were operated on during weekends were younger in age compared to weekdays (32 vs. 30 years old, p-value=0.019).
Our study indicated that weekend admissions were associated with more complications, and they are more likely to be delayed for surgery than weekday admissions. In addition, the frequency of emergency general surgeries is reduced during the weekends. Knowing the outcomes of admissions and surgeries performed during the weekends might assist in staffing, resource allocation and other measures that might be required during weekends.