Journal article
Is there a "weekend effect" in emergency general surgery?
- Abstract:
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Background
Weekend admission is associated with increased mortality across a range of patient populations and healthcare systems. The aim of this study was to determine whether weekend admission is independently associated with serious adverse events (SAE), in-hospital mortality, or failure to rescue (FTR) in emergency general surgery (EGS).
Methods
An observational study using the National Inpatient Sample (NIS) 2012-2013; the largest all-payer inpatient database in the United States, which represents a 20% stratified sample of hospital discharges. The inclusion criteria were all inpatients with a primary EGS diagnosis. Outcomes were SAE, in-hospital mortality, and FTR (in-hospital mortality in the population of patients that developed an SAE). Logistic multivariable regression models were used to adjust for patient- (age, sex, race, payer status, Charlson comorbidity index) and hospital-level (trauma designation, hospital bed size) characteristics.
Results
There were 1,344,828 individual patient records (6.7 million weighted admissions). The overall rate of SAE was 15.1% (15.1% weekend, 14.9% weekday, p<0.001), FTR 5.9% (6.2% weekend, 5.9% weekday, p=0.010), and in-hospital mortality 1.4% (1.5% weekend, 1.3% weekday, p<0.001). Within logistic regression models, weekend admission was an independent risk factor for development of SAE (aOR 1.08, 1.07-1.09), FTR (1.05, 1.01-1.10), and in-hospital mortality (1.14, 1.10-1.18).
Conclusion
This study found evidence that outcomes coded in an administrative dataset are marginally worse for EGS patients admitted at weekends. This justifies further work using clinical datasets that can be used to better control for differences in case mix.
- Publication status:
- Published
- Peer review status:
- Peer reviewed
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- Files:
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(Preview, Accepted manuscript, pdf, 372.8KB, Terms of use)
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- Publisher copy:
- 10.1016/j.jss.2017.10.019
Authors
- Publisher:
- Elsevier
- Journal:
- Journal of Surgical Research More from this journal
- Volume:
- 222
- Pages:
- 219-224
- Publication date:
- 2017-12-20
- Acceptance date:
- 2017-10-12
- DOI:
- EISSN:
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1095-8673
- ISSN:
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0022-4804
- Keywords:
- Pubs id:
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pubs:737399
- UUID:
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uuid:2b176256-a855-42f9-8ccc-4236bec56411
- Local pid:
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pubs:737399
- Source identifiers:
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737399
- Deposit date:
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2017-10-20
- ARK identifier:
Terms of use
- Copyright holder:
- Elsevier Inc
- Copyright date:
- 2017
- Notes:
- © 2017 Elsevier Inc. All rights reserved. This is the accepted manuscript version of the article. The final version is available online from Elsevier at: https://doi.org/10.1016/j.jss.2017.10.019
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