Components of Hospital Perioperative Infrastructure Can Overcome the Weekend Effect in Urgent General Surgery Procedures

Kothari, Anai N.; Zapf, Matthew; Blackwell, Robert H.; Markossian, Talar; Chang, Victor; Mi, Zhiyong; Gupta, Gopal N.; Kuo, Paul C.

doi:10.1097/sla.0000000000001436

Cited by 39 publications

(34 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…37,38 In particular, the under-reported incidence of low-revenue diagnoses is worth further discussion. A potential exists for systemic undercoding for diagnostic categories without a large financial incentive for accurate documentation.…”

Section: Discussionmentioning

confidence: 99%

Transient postoperative atrial fibrillation after abdominal aortic aneurysm repair increases mortality risk

Kothari

Halandras

Drescher

et al. 2016

Journal of Vascular Surgery

Self Cite

View full text Add to dashboard Cite

Objective The purpose of this study was to determine whether new-onset transient postoperative atrial fibrillation (TPAF) affects mortality rates after abdominal aortic aneurysm (AAA) repair and to identify predictors for the development of TPAF. Methods Patients who underwent open aortic repair or endovascular aortic repair for a principal diagnosis AAA were retrospectively identified using the Healthcare Cost and Utilization Project-State Inpatient Database (Florida) for 2007 to 2011 and monitored longitudinally for 1 year. Inpatient and 1-year mortality rates were compared between those with and without TPAF. TPAF was defined as new-onset atrial fibrillation that developed in the postoperative period and subsequently resolved in patients without a history of atrial fibrillation. Cox proportional hazards models, adjusted for age, gender, comorbidities, rupture status, and repair method, were used to assess 1-year survival. Predictive models were built with preoperative patient factors using Chi-squared Automatic Interaction Detector decision trees and externally validated on patients from California. Results A 3.7% incidence of TPAF was identified among 15,148 patients who underwent AAA repair. The overall mortality rate was 4.3%. The inpatient mortality rate was 12.3% in patients with TPAF vs 4.0% in those without TPAF. In the ruptured setting, the difference in mortality was similar between groups (33.7% vs 39.9%, P = .3). After controlling for age, gender, comorbid disease severity, urgency (ruptured vs nonruptured), and repair method, TPAF was associated with increased 1-year postoperative mortality (hazard ratio, 1.48; P < .001) and postdischarge mortality (hazard ratio, 1.56; P = .028). Chi-squared Automatic Interaction Detector-based models (C statistic = 0.70) were integrated into a Web-based application to predict an individual's probability of developing TPAF at the point of care. Conclusions The development of TPAF is associated with an increased risk of mortality in patients undergoing repair of nonruptured AAA. Predictive modeling can be used to identify those patients at highest risk for developing TPAF and guide interventions to improve outcomes. (J Vasc Surg 2016;63:1240-7.)

show abstract

Section: Discussionmentioning

confidence: 99%

Transient postoperative atrial fibrillation after abdominal aortic aneurysm repair increases mortality risk

Kothari

Halandras

Drescher

et al. 2016

Journal of Vascular Surgery

Self Cite

View full text Add to dashboard Cite

show abstract

“…25 Such hospitals may possess qualities that are protective against the weekend effect and identifying these institutional characteristics may offer insight into overcoming this quality lapse in operative care. Studying these qualities in a prospective setting could offer unique insight into the weekend effect and cost effective mechanisms to bolster weekend perioperative care.…”

Section: Discussionmentioning

confidence: 99%

The “weekend effect” in urgent general operative procedures

Zapf¹,

Kothari²,

Markossian³

et al. 2015

Surgery

Self Cite

View full text Add to dashboard Cite

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.

show abstract

“…16 The rate of laparoscopic appendectomies has been shown to significantly decrease on weekends despite no variation in appendicitis rates on any given day, a finding which may be attributed to insufficient hospital resources. 17,18 One possible reason for the observed weekend decrease in CS probability is the result of a lack of standardization of CS practices across various hospitals. Although guidelines for CS currently exist, a study by Toumi et al has indicated that the mere presence of a checklist could significantly decrease the rate of CS.…”

Section: Discussionmentioning

confidence: 99%