E. Abotsi1, G. Gilot1, G. Ortega1, C. K. Zogg2, D. J. Taghipour1, D. D. Tran1, E. E. Cornwell1, K. Hughes1 1Howard University College Of Medicine,Department Of Surgery,Washington, DC, USA 2Yale University School Of Medicine,Washington, DC, USA
Introduction:
Studies have demonstrated that there may be an increased risk of postoperative complications for certain surgical procedures when performed during weekends. This “weekend effect”, however, not been studied for vascular surgical procedures such as lower extremity arterial reconstruction (LEAR). Our objective is to determine if emergent LEAR performed on weekends differ in outcomes as compared to operations performed on weekdays utilizing a national database.
Methods:
We conducted a retrospective review of the Nationwide Inpatient Sample (NIS) database from 2007 to 2012, identifying patients who had undergone a LEAR. Patient characteristics including demographics and comorbid conditions were recorded as well as post-operative morbidity and mortality. Operations were dichotomized into Weekday (Mon-Fri) and Weekend (Saturday and Sunday). The two groups were compared utilizing t-test and Chi-Square analysis. Postoperative outcomes were evaluated using multivariate analysis adjusting for patient characteristics and comorbidities.
Results:
A total of 74,236 patients underwent emergent LEAR. Of those, the majority was non-Hispanic White (70%), male (61%), with a mean age of 67 years (SD + 14). The most common comorbid condition was hypertension (65%), followed by diabetes mellitus (31%), respiratory [defined as a diagnosis of chronic obstructive pulmonary disease] (27%), and renal [defined as a diagnosis of dialysis-dependent renal failure (20%). Most operations were performed during the weekday (85%, n=62,946). Comparing the groups Weekday and Weekend, patients on the weekend were majority male (63% vs. 61%, p<0.001) and younger (67 vs. 65 years, p<0.001).
Patients undergoing LEAR on the weekend experienced significantly higher rates of mortality (5.2 vs. 7.9%, p<0.001), wound infection (2.5% vs. 3.3%, p<0.001), and graft infection (12.4% vs. 14.4%, p<0.001). Risk-adjusted differences exhibited similar patterns: mortality OR: 1.47, 95%CI: 1.33-1.62; wound infection OR: 1.32, 95%CI: 1.15-1.52; and graft infection OR: 1.11, 95%CI: 1.04-1.20.
Conclusion:
Emergent LEAR performed on a weekend is associated with an increased risk of post-operative morbidity and mortality as compared to LEAR operations performed on a weekday. While reasons for this disparity are currently unclear, further investigation into the specific reasons is certainly warranted.