G. Gilot1, E. Abotsi1, G. Ortega1, C. Zogg2, D. Taghipour1, D. Tran1, E. Cornwell1, K. Hughes1 1Howard University College Of Medicine,Department Of Surgery,Washington, DC, USA 2Yale University School Of Medicine,New Haven, CT, 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, has not been studied for vascular surgical procedures such as repair of an abdominal aortic aneurysm (AAA). We undertook this study to determine if repair of ruptured AAA (rAAA) performed on weekends differed in outcomes as compared to rAAA operations performed on weekdays.
Methods:
We conducted a retrospective review of the Nationwide Inpatient Sample (NIS) database to identify all patients who underwent an open or endovascular rAAA repair from 2007 to 2012. Data analyzed included patient characteristics including demographics and comorbidities, as well as postoperative morbidity and mortality. Operations were dichotomized into Weekday (Mon-Fri) and Weekend (Sat and Sun); and open versus endovascular. Multivariate analysis was performed adjusting for patient characteristics and comorbidities to evaluate postoperative outcomes by groups.
Results:
A total of 15,418 patients had a rAAA repair. The majority were non-Hispanic White (87%), males (72%), with a mean age of 75 (SD±10) years. Overall mortality was 47.8%. Postoperative complications occurred in 30.5% of patients.
In those undergoing open repair, (n=6,623), the mean age was 73 (SD±9) years with an overall mortality of 39.5% and overall complication rate of 43.1%. Most open rAAA repairs were performed on a weekday (72.4%). Comparing weekday versus weekend, open rAAA repair, there were similar rates of mortality (40.6% weekday vs. 39.1% weekend; p=0.264) and morbidity (43.5% weekday vs. 42.9% weekend; P=0.693).
In those undergoing endovascular repair, (n=2,170), the mean age was 74 (SD±10) years with an overall mortality of 26.5% and morbidity of 31.6%. The mortality rate was 26.5%. The in-hospital complication rate was 31.6%. A majority of operations were performed on a weekday (75.2%). Comparing weekday versus weekend endovascular rAAA repair, there were similar rates of mortality (24.5% weekday vs. 32.7% weekend; OR [95%CI]: 1.30 [0.87-1.96]) and morbidity (31.9% weekday vs. 31.5% weekend; p=0.843).
Conclusion:
rAAA repair is associated with equivalent outcomes when performed on the weekend vs weekday. Endovascular repair of rAAA is associated with superior outcomes.