D. Metcalfe1, O. A. Olufajo6, A. J. Rios-Diaz5, C. K. Zogg4, R. Chowdhury2, J. M. Havens2, A. Haider2, A. Salim2,3 6Washington University School Of Medicine,Department Of Surgery,St Louis, MO, USA 1University Of Oxford,Kadoorie Centre For Critical Care Research,Oxford, OXFORDSHIRE, United Kingdom 2Brigham And Women’s Hospital,Center For Surgery And Public Health,Boston, MA, USA 3Harvard Medical School,Boston, MA, USA 4Yale University School Of Medicine,New Haven, CT, USA 5Thomas Jefferson University Hospital,Department Of Surgery,Philadelphia, PA, USA
Introduction:
Weekend admission is associated with increased mortality across a range of patient populations and healthcare systems. However, it is unknown whether this “weekend effect” exists in emergency general surgery (EGS). The aim of this study was to determine whether weekend admission is independently associated with serious adverse events (SAE), in-hospital mortality, or failure to rescue (FTR) in an EGS population.
Methods:
An observational study using the Nationwide Inpatient Sample (NIS) 2001-2011; the largest all-payer inpatient database in the United States, which represents a 20% stratified sample of hospital admissions. The inclusion criteria were all inpatients with a primary ICD-9-CM diagnosis of acute appendicitis, abdominal cavity hernia (obstructed or strangulated), intestinal obstruction, or peritonitis. Outcomes were SAE, in-hospital mortality, and FTR (in-hospital mortality in the population of patients that developed an SAE). Logistic multivariable regression models were used to adjust for patient- (age, sex, race, payer status, Charlson comorbidity index) and hospital-level (trauma designation, hospital bed size) characteristics.
Results:
There were 758,915 individual patient records (3.7 million weighted admissions). The overall rate of SAE was 10.6% (10.9% weekend, 10.5% weekday, p<0.001), in-hospital mortality 1.4% (1.4% weekend, 1.4% weekday, p=0.048), and FTR 8.7% (8.7% weekend, 8.7% weekday, p=0.819). Within logistic regression models, weekend admission was an independent risk factor for development of SAE (1.04, 1.02-1.06) but not for FTR (0.98, 0.91-1.05) or in-hospital mortality (1.01, 0.95-1.07).
Conclusion:
This study did not find any evidence of increased mortality for EGS patients admitted at the weekend.