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Weekend Admissions Associated with Increased Length of Stay for Children Undergoing Cholecystectomy
Danny Lascano1, Rachel Lai2, Gustavo Stringel1
1Department of Surgery, New York Medical College, Westchester Medical Center, Valhalla, NY.
Insights
Weekend admissions for pediatric nonelective cholecystectomy are linked to longer hospital stays (length of stay or LOS). This study found weekend admissions increased LOS by nearly two-fold in children undergoing gallbladder surgery.
Area of Science:
- Pediatric Surgery
- Health Services Research
- Biliary Disease Management
Background:
- Previous studies indicate a correlation between weekend surgical admissions and extended length of stay (LOS).
- However, the impact of weekend admissions on pediatric nonelective cholecystectomy for benign noncongenital biliary disease remains under-examined.
Purpose of the Study:
- To investigate whether weekend admissions are associated with a longer LOS in pediatric patients undergoing nonelective cholecystectomy for benign noncongenital biliary disease.
- To analyze the impact of admission timing on healthcare resource utilization in this specific pediatric surgical population.
Main Methods:
- Utilized the Statewide Planning and Research Cooperative System database for pediatric patients (≤17 years) undergoing cholecystectomy in New York State (2009-2012).
- Employed parametric and nonparametric statistical testing for univariate analysis.
- Applied multivariable binary logistic regression and linear regression models for multivariable analysis, with statistical significance set at p < 0.05.
Main Results:
- A total of 1066 pediatric patients underwent nonelective cholecystectomy for benign biliary conditions.
- Weekend admissions (22.1% of cases) were associated with a significantly increased median length of stay (4 days vs. 3 days, p < 0.001).
- Multivariable analysis revealed weekend admission was associated with 1.924 adjusted odds of increased length of stay (95% CI: 1.386-2.673).
Conclusions:
- Weekend admissions are independently associated with increased length of stay for children requiring nonelective cholecystectomy.
- This association persists despite the prevalent use of minimally invasive laparoscopic surgery in this pediatric cohort.
- Findings suggest potential inefficiencies in care delivery or resource allocation for weekend surgical admissions in pediatric biliary disease.
Background And Objectives:
Prior research shows an association between increased length of stay (LOS) and weekend surgical admissions, but none have looked at this relationship in children undergoing nonelective cholecystectomy for benign noncongenital biliary disease. We investigated whether weekend admissions lead to a longer LOS in this patient population.
Methods:
The Statewide Planning and Research Cooperative System database was queried for children ≤ 17 years undergoing cholecystectomy in New York State between January 1, 2009 and December 31, 2012. Parametric and nonparametric statistical testing was used for univariate analysis; multivariable binary logistic regression and linear regression models were used for multivariable analysis. Statistical significance was < 0.05.
Results:
A total of 1066 pediatric patients underwent nonelective cholecystectomy for gallstone pancreatitis (9.7%) and other benign biliary noncongenital diseases (90.3%), of which 22.1% of all patients were admitted over the weekend. Most cases (97.2%) were treated laparoscopically with an overall 3-day median LOS. Weekend admission was associated with an increased LOS of 4 days as opposed to 3 days during the weekday (p < 0.001). On a multivariable binary logistic regression model controlling for hospital factors, indication for surgery, and comorbidities, weekend admission was associated with 1.92 odds of increased length of stay (adjusted odds ratio of 1.924, 95% confidence interval: 1.386-2.673).
Conclusion:
Weekend admissions were associated with increased LOS and charges for children requiring nonelective cholecystectomy, despite the wide use of laparoscopic surgery.
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