The "weekend effect" in pediatric surgery - Increased mortality for children undergoing urgent surgery during the weekend

Seth D. Goldstein, Dominic J. Papandria, Jonathan Aboagye, Jose H. Salazar, Kyle Van Arendonk, Khaled Al-Omar, Gezzer Ortega, Maria Grazia Sacco Casamassima, Fizan Abdullah

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1087-1091
Number of pages5
JournalJournal of Pediatric Surgery
Volume49
Issue number7
DOIs
StatePublished - 2014
Externally publishedYes

Fingerprint

Child Mortality
Pediatrics
Blood Transfusion
Inpatients
Logistic Models
Appendectomy
Inguinal Hernia
Herniorrhaphy
Abscess
Drainage
Databases
Hemorrhage
Morbidity
Mortality

Keywords

  • Kids' Inpatient Database
  • National Inpatient Sample
  • Patient safety
  • Pediatric surgery
  • Surgical outcomes
  • Weekend effect

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health
  • Medicine(all)

Cite this

Goldstein, S. D., Papandria, D. J., Aboagye, J., Salazar, J. H., Van Arendonk, K., Al-Omar, K., ... Abdullah, F. (2014). The "weekend effect" in pediatric surgery - Increased mortality for children undergoing urgent surgery during the weekend. Journal of Pediatric Surgery, 49(7), 1087-1091. https://doi.org/10.1016/j.jpedsurg.2014.01.001

The "weekend effect" in pediatric surgery - Increased mortality for children undergoing urgent surgery during the weekend. / Goldstein, Seth D.; Papandria, Dominic J.; Aboagye, Jonathan; Salazar, Jose H.; Van Arendonk, Kyle; Al-Omar, Khaled; Ortega, Gezzer; Sacco Casamassima, Maria Grazia; Abdullah, Fizan.

In: Journal of Pediatric Surgery, Vol. 49, No. 7, 2014, p. 1087-1091.

Research output: Contribution to journalArticle

Goldstein, SD, Papandria, DJ, Aboagye, J, Salazar, JH, Van Arendonk, K, Al-Omar, K, Ortega, G, Sacco Casamassima, MG & Abdullah, F 2014, 'The "weekend effect" in pediatric surgery - Increased mortality for children undergoing urgent surgery during the weekend', Journal of Pediatric Surgery, vol. 49, no. 7, pp. 1087-1091. https://doi.org/10.1016/j.jpedsurg.2014.01.001
Goldstein, Seth D. ; Papandria, Dominic J. ; Aboagye, Jonathan ; Salazar, Jose H. ; Van Arendonk, Kyle ; Al-Omar, Khaled ; Ortega, Gezzer ; Sacco Casamassima, Maria Grazia ; Abdullah, Fizan. / The "weekend effect" in pediatric surgery - Increased mortality for children undergoing urgent surgery during the weekend. In: Journal of Pediatric Surgery. 2014 ; Vol. 49, No. 7. pp. 1087-1091.
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abstract = "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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AU - Papandria, Dominic J.

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AU - Salazar, Jose H.

AU - Van Arendonk, Kyle

AU - Al-Omar, Khaled

AU - Ortega, Gezzer

AU - Sacco Casamassima, Maria Grazia

AU - Abdullah, Fizan

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N2 - 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.

AB - 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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