Worse outcomes in patients undergoing urgent surgery for left-sided diverticulitis admitted on weekends vs weekdays: a population-based study of 31 832 patients.
ABSTRACT 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.
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ABSTRACT: Previous research has demonstrated that patients undergoing elective surgery on the weekend had an adjusted risk of 30-day mortality that was significantly higher than that of patients operated upon during the week. The generalizability of this association and effect size is unknown. The aim of this study was to investigate the generalizability of the association between elective weekend surgery and increased 30-day postoperative mortality. A retrospective, propensity score-matched cohort analysis of linked population-based health administrative data was carried out. Individuals undergoing elective, intermediate, intermediate-risk to high-risk all describe the noncardiac surgery exposure at all acute care hospitals in Ontario, Canada, between 2002 and 2012 were included. Elective surgery was performed on the weekends. All-cause mortality was measured within 30 days of the operation. A total of 333,344 patients were studied, of whom 2826 died within 30 days of surgery (overall crude mortality rate 8.5 deaths per 1000). Weekend elective surgery was performed on 2520 patients, of whom 2518 were successfully propensity score matched to weekday surgical patients. Undergoing elective surgery on the weekend was associated with a 1.96 times higher odds of 30-day mortality than weekday surgery (95% confidence interval, 1.36-2.84) in a propensity-matched analysis. This significant increase in the odds of postoperative mortality was confirmed using a multivariable logistic regression analysis (odds ratio 1.51; 95% confidence interval, 1.19-1.92). Similar to previous studies in distinct health care systems, patients in Ontario undergoing elective surgery on the weekend experienced an increased risk of 30-day postoperative mortality. Mechanisms underlying this effect require further study.Medical care 04/2014; 52(6). DOI:10.1097/MLR.0000000000000137 · 2.94 Impact Factor
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ABSTRACT: To determine if single nuclear polymorphisms (SNPs) in the TFNSF15 gene play a role in patients requiring surgery for diverticulitis. A role for a genetic predisposition in diverticulitis is suggested by its association with hereditary connective tissue disorders, youthful onset in some patients, and the observation of families with multiple affected individuals. The TNFSF15 gene has been associated with other inflammatory diseases affecting the colon such as medically refractory ulcerative colitis (UC), aggressive Crohn's disease (CD), and pouchitis after restorative proctocolectomy. In the discovery phase of this study, 21 sporadic surgical diverticulitis (SD) patients (9 female, mean age = 52 ± 5) and 5 individuals from a single family with surgically managed diverticulitis [familial diverticulitis (FD), 4 female, mean age = 51.1 ± 7] were studied. SD patients were age and sex matched with 3 separate groups of healthy, CD and UC control patients. All patients were genotyped for 5 known TNFSF15-associated SNPs. The SNP discovered to be associated with diverticulitis (rs7848647) was then confirmed in a separate test group composed of 34 additional patients (20 female, mean age 57.7 ± 2) who also underwent surgical treatment for diverticulitis. These patients were age matched to a new control cohort of patients having no history of diverticulitis (26 female). Patients were genotyped using a TaqMan assay. In the discovery phase, logistical regression on matched subjects was performed to determine an association of TNFSF SNP with diverticulitis versus the control groups. In the test phase, significance for the rs7848647 SNP was assessed by the Fischer's exact test. In the discovery phase, the TNFSF15 SNP rs7848647 was significantly associated with SD (p = 0.0003) versus all control groups studied. The risk allele for this SNP (G substituted for A) was found in all SD patients. The homozygous GG allele was found in 62% (13/21) of SD patients versus only 5% (1/21) of healthy controls (p = 0.001) and 24% (10/42) of all UC + CD controls (p = 0.002). All 5 members of the FD cohort were homozygous for the at-risk "G" allele. In the test group, the homozygous GG genotype was found in 56% of SD patients compared with 17% of healthy controls (p = 0.006). Risk of SD seemed to increase with number of the G alleles with 8% of SD patients having AA homozygosity, 35% of SD patients having AG heterozygosity, and 56% of SD patients having GG homozygosity. The SNP rs7848647 associated with the TNFSF15 gene is associated with surgical diverticulitis. This finding suggests a fundamental role for TNFSF15, a T-cell receptor gene involved in T-cell maturation, in the pathophysiology of diverticulitis requiring surgery. This SNP may be a marker of diverticular disease severity that might assist in surgical decision making.Annals of surgery 06/2014; 259(6):1132-7. DOI:10.1097/SLA.0000000000000232 · 7.19 Impact Factor
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ABSTRACT: 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.07/2014; 2(3). DOI:10.1093/gastro/gou043This article is viewable in ResearchGate's enriched formatRG Format enables you to read in context with side-by-side figures, citations, and feedback from experts in your field.