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The "weekend effect" in pediatric surgery - increased mortality for children undergoing urgent surgery during the
Seth D Goldstein1, Dominic J Papandria1, Jonathan Aboagye1
1Center for Pediatric Surgical Clinical Trials & Outcomes Research, Division of Pediatric Surgery, Johns Hopkins University School of Medicine.
Insights
Pediatric surgery outcomes are worse on weekends. Children undergoing urgent procedures on weekends face higher risks of death, blood transfusions, and complications compared to weekdays.
Area of Science:
- Pediatric Surgery
- Healthcare Outcomes Research
- Hospital Systems Analysis
Background:
- Weekend hospital admissions are associated with increased morbidity and mortality for various conditions.
- There is a need to evaluate the impact of admission timing on pediatric surgical patient outcomes.
Purpose of the Study:
- To compare pediatric surgical outcomes between weekend and weekday procedures.
- To identify potential disparities in care based on the day of admission for pediatric surgical patients.
Main Methods:
- Analysis of Nationwide Inpatient Sample and Kids' Inpatient Database (1988-2010).
- Inclusion of 439,457 pediatric admissions requiring specific index surgical procedures on the day of admission.
- Logistic regression models adjusted for patient and hospital characteristics to compare outcomes.
Main Results:
- Weekend admissions (n=112,064) were similar to weekday admissions (n=327,393) in patient characteristics but more likely to be emergent (61% vs 53%).
- Weekend procedures were associated with significantly higher adjusted odds of mortality (OR 1.63), blood transfusion (OR 1.15), and procedural complications (OR 1.40).
Conclusions:
- Pediatric patients undergoing urgent surgery on weekends have an increased risk of adverse outcomes, including death, transfusion, and complications.
- The findings suggest potential systems-based deficiencies impacting pediatric surgical care during weekend admissions.
- Timing of surgical procedures should be considered in efforts to improve pediatric surgical care quality.
Background:
For a number of pediatric and adult conditions, morbidity and mortality are increased when patients present to the hospital on a weekend compared to weekdays. The objective of this study was to compare pediatric surgical outcomes following weekend versus weekday procedures.
Methods:
Using the Nationwide Inpatient Sample and the Kids' Inpatient Database, we identified 439,457 pediatric (<18 years old) admissions from 1988 to 2010 that required a selected index surgical procedure (abscess drainage, appendectomy, inguinal hernia repair, open fracture reduction with internal fixation, or placement/revision of ventricular shunt) on the same day of admission. Outcome metrics were compared using logistic regression models that adjusted for patient and hospital characteristics as well as procedure performed.
Results:
Patient characteristics of those admitted on the weekend (n=112,064) and weekday (n=327,393) were similar, though patients admitted on the weekend were more likely to be coded as emergent (61% versus 53%). After multivariate adjustment and regression, patients undergoing a weekend procedure were more likely to die (OR 1.63, 95% CI 1.21-2.20), receive a blood transfusion despite similar rates of intraoperative hemorrhage (OR 1.15, 95% CI 1.01-1.26), and suffer from procedural complications (OR 1.40, 95% CI 1.14-1.74).
Conclusion:
Pediatric patients undergoing common urgent surgical procedures during a weekend admission have a higher adjusted risk of death, blood transfusion, and procedural complications. While the exact etiology of these findings is not clear, the timing of surgical procedures should be considered in the context of systems-based deficiencies that may be detrimental to pediatric surgical care.
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