Understanding the “Weekend Effect” for Emergency General Surgery

Hoehn, Richard S.; Go, Derek E.; Dhar, Vikrom K.; Kim, Young; Hanseman, Dennis J.; Wima, Koffi; Shah, Shimul A.

doi:10.1007/s11605-017-3592-x

Cited by 38 publications

(51 citation statements)

References 17 publications

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“…With the exception of living donation, there is no elective surgery in transplant surgery, which could be another explanation for an absent weekend effect in our cohort. It was suggested that patients admitted to hospitals on weekends or requiring surgery on weekends might suffer from more acute, life-threatening diseases, which in turn may confound differences in their outcomes [ 15 ]. In our cohort, we could exclude this factor since we found no significant differences in MELD score, HU-status or indication for oLT.…”

Section: Discussionmentioning

confidence: 99%

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The weekend effect in liver transplantation

et al. 2018

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BackgroundThe weekend effect describes a phenomenon whereby patients admitted to hospitals on weekends are at higher risk of complications compared to those admitted during weekdays. However, if a weekend effect exists in orthotopic liver transplantation (oLT).MethodsWe analyzed oLT between 2006 and 2016 and stratified patients into weekday (Monday to Friday) and weekend (Saturday, Sunday) groups. Primary outcome measures were one-year patient and graft survival.Results364 deceased donor livers were transplanted into 329 patients with 246 weekday (74.77%) and 83 weekend (25.23%) patients. Potential confounders (e.g. age, ischemia time, MELD score) were comparable. One-year patient and graft survival were similar. Frequencies of rejections, primary-non function or re-transplantation were not different. The day of transplantation was not associated with one-year patient and graft survival in multivariate analysis.ConclusionsWe provide the first data for the Eurotransplant region on oLT stratified for weekend and weekday procedures and our findings suggest there was no weekend effect on oLT. While we hypothesize that the absent weekend effect is due to standardized transplant procedures and specialized multidisciplinary transplant teams, our results are encouraging showing oLT is a safe and successful procedure, independent from the day of the week.

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Section: Discussionmentioning

confidence: 99%

“…Additionally, a growing body evidence points towards a weekend effect for conditions requiring emergency surgery e.g. ruptured aortic aneurysms [ 14 ] as well as emergency procedures in general surgery such as laparotomy, partial colectomy or small bowel resection [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

The weekend effect in liver transplantation

et al. 2018

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“…Emergency admissions and in-patients requiring emergency care constitute the majority of the weekend caseload. A number of studies have observed a weekend effect for emergency surgical admissions [ [13] , [14] , [15] , [16] , [17] ]. However, large studies demonstrate disagreements on the presence of a weekend effect.…”

Section: Introductionmentioning

confidence: 99%

The weekend effect – How can it be mitigated? Introduction of a consultant-delivered emergency general surgical service

Somasundram

Neville

Sinha

et al. 2020

Annals of Medicine and Surgery

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Background Poorer patient outcomes for emergency general surgery have been observed in patients admitted to hospital over the weekend. This paper reports the outcomes of a Consultant-delivered service model for weekend admissions and its impact for patients undergoing emergency laparotomy. Methods Operative data was analysed from a prospectively collected database over 5-years. Primary outcome measures were 30-day all-cause mortality and Clavien-Dindo class ≥2 morbidity. Secondary outcomes included time from admission to diagnostic imaging and time to surgery, post-operative length of stay and requirement for Intensive Care Unit admission. Results 263 patients underwent an emergency laparotomy. Overall 30-day mortality was 4.6% and all-cause morbidity was 55.9%. The most common indications for laparotomy were mechanical small bowel obstruction (32.7%) and hollow viscus perforation (30.4%) of the 263 emergency laparotomies, 92 patients in the cohort were weekend admissions (Saturday or Sunday). There was no significant difference amongst patients admitted during the weekend in ASA grade, age, gender, or proportion of patients receiving a pre-operative computed tomography scan, when compared to those during the week. Compared to weekdays, weekend admission was not associated with a significant difference in mortality (5.3% and 3.3%, respectively p = 0.458), all-cause morbidity (p = 0.509), post-operative length of stay (p = 0.681), or Intensive Care Unit admission (p = 0.761). Conclusion A Consultant Surgeon delivered emergency service can avoid the poor patient outcomes associated with weekend admissions and the ‘weekend effect’.

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“…Despite the breadth of research into the phenomena, an understanding of the ways in which the weekend effect manifests remains elusive and often inconsistent [2, 15, 16]. In a prominent editorial published in BMJ Quality and Safety , Richard Lilford and Yen-Fu Chen suggest further work in replicating the weekend effect no longer serves a useful purpose [17].…”

Section: Introductionmentioning

confidence: 99%

Examining the weekend effect across ICU performance metrics

2019

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Background Known colloquially as the “weekend effect,” the association between weekend admissions and increased mortality within hospital settings has become a highly contested topic over the last two decades. Drawing interest from practitioners and researchers alike, a sundry of works have emerged arguing for and against the presence of the effect across various patient cohorts. However, it has become evident that simply studying population characteristics is insufficient for understanding how the effect manifests. Rather, to truly understand the effect, investigations into its underlying factors must be considered. As such, the work presented in this manuscript serves to address this consideration by moving beyond identification of patient cohorts to examining the role of ICU performance. Methods Employing a comprehensive, publicly available database of electronic medical records (EMR), we began by utilizing multiple logistic regression to identify and isolate a specific cohort in which the weekend effect was present. Next, we leveraged the highly detailed nature of the EMR to evaluate ICU performance using well-established ICU quality scorecards to assess differences in clinical factors among patients admitted to an ICU on the weekend versus weekday. Results Our results demonstrate the weekend effect to be most prevalent among emergency surgery patients (OR 1.53; 95% CI 1.19, 1.96), specifically those diagnosed with circulatory diseases ( P <.001). Differences between weekday and weekend admissions for this cohort included a variety of clinical factors such as ventilatory support and night-time discharges. Conclusions This work reinforces the importance of accounting for differences in clinical factors as well as patient cohorts in studies investigating the weekend effect.

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Understanding the “Weekend Effect” for Emergency General Surgery

Cited by 38 publications

References 17 publications

The weekend effect in liver transplantation

The weekend effect in liver transplantation

The weekend effect – How can it be mitigated? Introduction of a consultant-delivered emergency general surgical service

Examining the weekend effect across ICU performance metrics

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