The effect of weekend and after-hours surgery on morbidity and mortality rates in pediatric neurosurgery patients

Abstract

P ediatric neurosurgeons frequently perform emergency surgical procedures outside "regular" operating room hours due to the time-sensitive nature of disease processes and because delays in care may contribute to adverse outcomes. However, operating room staffing and hospital resource availability are variable outside of the conventional Monday through Friday work week.There is a growing body of literature that suggests increased rates of morbidity and mortality for a number of pediatric and adult conditions when patients present to the hospital on a weekend compared with weekdays. [1][2][3][4][5][6][7][8][11][12][13][14][15][16]19,20,[23][24][25] The "weekend effect" on pediatric neurosurgical procedures is unknown. Therefore, our primary aim was to abbreviation ASA = American Society of Anesthesiologists. obJect Several studies have indicated that the 30-day morbidity and mortality risks are higher among pediatric and adult patients who are admitted on the weekends. This "weekend effect" has been observed among patients admitted with and for a variety of diagnoses and procedures, including myocardial infarction, pulmonary embolism, ruptured abdominal aortic aneurysm, stroke, peptic ulcer disease, and pediatric surgery. In this study, morbidity and mortality outcomes for emergency pediatric neurosurgical procedures carried out on the weekend or after hours are compared with emergency surgical procedures performed during regular weekday business hours. methods A retrospective analysis of operative data was conducted. Between December 1, 2011, and August 20, 2014, a total of 710 urgent or emergency neurosurgical procedures were performed at Texas Children's Hospital in children younger than than 18 years of age. These procedures were then stratified into 3 groups: weekday regular hours, weekday after hours, and weekend hours. By cross-referencing these events with a prospectively collected morbidity and mortality database, the impact of the day and time on complication incidence was examined. Outcome metrics were compared using logistic regression models. results The weekday regular hours and after-hours (weekday after hours and weekends) surgery groups consisted of 341 and 239 patients and 434 and 276 procedures, respectively. There were no significant differences in the types of cases performed (p = 0.629) or baseline preoperative health status as determined by American Society of Anesthesiologists classifications (p = 0.220) between the 2 cohorts. After multivariate adjustment and regression, children undergoing emergency neurosurgical procedures during weekday after hours or weekends were more likely to experience complications (p = 0.0227). conclusions Weekday after-hours and weekend emergency pediatric neurosurgical procedures are associated with significantly increased 30-day morbidity and mortality risk compared with procedures performed during weekday regular hours.

Paediatric outcomes and timing of admission

“…There appears to be a weekend effect regarding certain procedural complications. In a retrospective cohort of 580 patients less than 18 years of age undergoing 710 urgent or emergency neurosurgical procedures in a Texas Children’s Hospital, there was a significant excess of surgical complications at weekends and weekdays after-hours 10. In a small study of 28 patients undergoing oesophageal atresia and trachea-oesophageal repair, there were significantly more oesophageal leaks in those admitted after-hours23 and this was associated with a longer postoperative length of ventilation (16.1 vs 9.3 days) 23.…”

After-hours elective spine deformity corrective surgery for patients with Adolescent Idiopathic Scoliosis: Is it safe?

“…There were studies that documented surgeries done afterhours carried higher morbidity and mortality. [3][4][5][6][7][8][9][10][11] Chacko et al 3 performed a retrospective study of 767 consecutive patients with intertrochanteric, subtrochanteric, or femoral neck fractures and found that the duration of surgery, blood loss, and postoperative mortalities were significantly less for surgery done during the day compared with night. Ricci et al 4 conducted a prospective study among 203 patients with femur and tibia fractures comparing surgeries done at daytime and after-hours.…”

“…Kelz et al 6 reported a retrospective study of 144,740 nonemergent general and vascular surgical procedures, comparing the operation start time of 7 a.m. to 4 p.m., 4 p.m. to 6 p.m., and 6 p.m. to 11 p.m. and found that morbidity was significant higher when the operation start time was later in the day. Desai et al 7 performed a retrospective study on 710 urgent or emergency pediatric neurosurgical procedures and found that 30-day morbidity and mortality were significantly higher when these procedures were done during the weekend or after-hours. Komen et al 8 found that anastomosis leakage was significantly higher among patient who underwent a primary colorectal anastomosis operation during after-hours compared with daytime.…”

Surgical outcome of daytime and out-of-hours surgery for elderly patients with hip fracture

“…The Hospital Authority (HA) (10)) were selected from CDARS. Records were also reviewed through the CMS for verification.…”

“…[10][11][12] Scant literature on the effect of time of the day of operation on hip surgery outcome shows controversial results.…”