Among patients undergoing urgent surgery for left-sided diverticulitis, those admitted on weekends vs weekdays have higher rates of Hartmann procedure and adverse outcomes.
Analysis of data from the Nationwide Inpatient Sample between January 2002 and December 2008. Unadjusted and risk-adjusted generalized linear regression models were used.
Data on patients undergoing urgent surgery for acute diverticulitis.
Rates of Hartmann procedure vs primary anastomosis, complications, length of hospital stay, and total hospital charges.
In total, 31 832 patients were included; 7066 (22.2%) were admitted on weekends, and 24 766 (77.8%) were admitted on weekdays. The mean (SD) age of patients was 60.8 (15.3) years, and 16 830 (52.9%) were female. A Hartmann procedure was performed in 4580 patients (64.8%) admitted on weekends compared with 13 351 patients (53.9%) admitted on weekdays (risk-adjusted odds ratio [OR], 1.57; P < .001). In risk-adjusted analyses, patients admitted on weekends had significantly higher risk for any postoperative complication (OR, 1.10; P = .005) and nonroutine hospital discharge (OR, 1.33; P < .001) compared with patients admitted on weekdays, as well as a median length of hospital stay that was 0.5 days longer and median total hospital charges that were $3734 higher (P < .001 for both).
Patients undergoing urgent surgery for left-sided diverticulitis who are admitted on a weekend have a higher risk for undergoing a Hartmann procedure and worse short-term outcomes compared with patients who are admitted on a weekday. Further research is warranted to investigate possible underlying mechanisms and to develop strategies for reducing this substantial weekend effect.
"Crowley and colleagues reported a 12% increased mortality for patients admitted on a weekend with an intra-cerebral hemorrhage, while others, such as Khanna and colleagues, showed no difference in medical patients’ outcomes for weekend admissions [9, 10]. The majority of studies reporting worse outcomes in patients admitted during the weekend have been concerned with patients who required urgent or emergency intervention; for instance, Worni and colleagues reported worse outcomes (increased re-operation and post-operative complications) in patients undergoing surgery for diverticulitis who were admitted on a weekend . "
[Show abstract][Hide abstract] ABSTRACT: Aims: To determine whether day and time of admission influences the practice patterns of the admitting general surgeon and subsequent outcomes for patients diagnosed with small bowel obstruction.
Methods: A retrospective database review was carried out, covering patients admitted with the presumed diagnosis of partial small bowel obstruction from 2004–2011.
Results: A total of 404 patients met the inclusion criteria. One hundred and thirty-nine were admitted during the day, 93 at night and 172 on the weekend. Overall 30.2% of the patients were managed operatively with no significant difference between the groups (P = 0.89); however, of patients taken to the operating room, patients admitted during the day received operative intervention over 24 hours earlier than those admitted at a weekend, 0.79 days vs 1.90 days, respectively (P = 0.05). Overall mortality was low at 1.7%, with no difference noted between the groups (P = 0.35). Likewise there was no difference in morbidity rates between the three groups (P = 0.90).
Conclusions: Despite a faster time to operative intervention in those patients admitted during the day, our study revealed that time of admission does not appear to correlate to patient outcome or mortality.
"Even if prompt access to operating facilities is possible, the rates of critical events and mortality are higher in emergency surgery . This setting is therefore an invariable risk factor for mortality and can be a strong confounder that masks other risk factors when emergency and scheduled patients are studied together , accounting for some of the variability in results. "
[Show abstract][Hide abstract] ABSTRACT: Abdominal surgeries for cancer are associated with postoperative complications and mortality. A view of the success of anaesthetic, surgical and critical care can be gained by analyzing factors associated with mortality in patients admitted to intensive care units (ICUs). The objective of this study was to identify the postoperative mortality rate and the causes of perioperative death in high-risk patients after abdominal surgery for cancer. A secondary objective was to explore possible risk factors for death in scheduled and emergency surgeries, with a view to finding guidance on preventable risk factors.
An observational study, in a 12-bed surgical ICU of a tertiary hospital. Patients admitted after abdominal surgery for cancer to the ICU for more than 24 hours' care were included from January 1, 2008--December 31, 2009. Data were extracted from the minimum basic dataset. The main outcome considered was 90-day mortality.
Of 899 patients included, 80 (8.9%) died. Seven died within 48 hours of surgery, 18 died between 2 and 7 days, and 55 died after 7 days. Non-survivors were older and had more respiratory comorbidity, chronic liver disease, metastasis, and underwent more palliative procedures. 112 patients underwent emergency surgery; mortality in these patients for resection surgery was 32.5%; in the 787 patients who underwent scheduled surgery, mortality was 4.7% for resection procedures. The estimated odds ratios (95% confidence interval) of preoperative patient factors in emergency surgery confirmed a negative association between survival and older age 0.96 (0.91--1), the presence of respiratory comorbidity 0.14 (0.02--0.77) and metastasis 0.18 (0.05--0.6). After scheduled surgery, survival was negatively associated with age 0.93 (0.90--0.96) and chronic liver disease 0.40 (0.17--0.91). Analysis of complications after emergency surgery also indicated a negative association with sepsis 0.03 (0.003--0.32), respiratory events 0.043 (0.011--0.17) and cardiac events 0.11 (0.027--0.45); after scheduled surgery, respiratory 0.03 (0.01--0.08) and cardiac 0.11 (0.02--0.45) events, renal failure 0.02 (0.006--0.14) and neurological events 0.06 (0.007--0.5).
As most deaths occurred after discharge from the ICU, postoperative sepsis, respiratory and cardiac events should be watched carefully on the ward.
Patient Safety in Surgery 09/2013; 7(1):29. DOI:10.1186/1754-9493-7-29
[Show abstract][Hide abstract] ABSTRACT: There is increasing complexity in the management of patients with acute severe exacerbation of inflammatory bowel disease [IBD; Crohn's disease (CD), ulcerative colitis (UC)] with frequent requirement for urgent surgery.
To determine whether a weekend effect exists for IBD care in the United States.
We used data from the Nationwide Inpatient Sample (NIS) 2007, the largest all-payer hospitalisation database in the United States. Discharges with a diagnosis of CD or UC who underwent urgent intestinal surgery within 2 days of hospitalisation were identified using the appropriate ICD-9 codes. The independent effect of admission on a weekend was examined using multivariate logistic regression adjusting for potential confounders.
Our study included 7,112 urgent intestinal surgeries in IBD patients, 21% of which occurred following weekend admissions. There was no difference in disease severity between weekend and weekday admissions. Post-operative complications were more common following weekend than weekday hospitalisations in UC [odds ratio (OR) 1.71, 95% confidence interval (CI) 1.01–2.90]. The most common post-operative complication was post-operative infections (Weekend 30% vs. weekday 20%, P = 0.04). The most striking difference between weekend and weekday hospitalisations was noted for needing repeat laparotomy (OR 11.5), mechanical wound complications (OR 10.03) and pulmonary complications (OR 2.22). In contrast, occurrence of any post-operative complication in CD was similar between weekday and weekend admissions.
Patients with UC hospitalised on a weekend undergoing urgent surgery within 2 days have an increased risk for post-operative complications, in particular mechanical wound complications, need for repeat laparotomy and post-operative infections.
Josephine Taylor Bates, Rodney J Weber, Joseph Abrams, Vishal Verma, Ting Fang, Mitchel Klein, Matthew Strickland, Stefanie Ebelt Sarnat, Howard H Chang, James A Mulholland, Paige E Tolbert, Armistead G Russell
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