Journal of Emergencies, Trauma, and Shock
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LETTER TO EDITOR  
Year : 2020  |  Volume : 13  |  Issue : 3  |  Page : 232
The impact of the “Weekend Effect” on emergency exploratory laparotomy surgeries outcomes at an urban level 1 trauma center


1 Department of Surgery, Kendall Regional Medical Center, Miami, Florida, USA
2 Department of Surgery, Kendall Regional Medical Center, Miami; Department of Surgery, University of South Florida, Tampa, Florida, USA

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Date of Submission04-Feb-2020
Date of Acceptance12-Feb-2020
Date of Web Publication18-Sep-2020
 

How to cite this article:
Elkbuli A, Zajd S, Dowd B, Hai S, Boneva D, McKenney M. The impact of the “Weekend Effect” on emergency exploratory laparotomy surgeries outcomes at an urban level 1 trauma center. J Emerg Trauma Shock 2020;13:232

How to cite this URL:
Elkbuli A, Zajd S, Dowd B, Hai S, Boneva D, McKenney M. The impact of the “Weekend Effect” on emergency exploratory laparotomy surgeries outcomes at an urban level 1 trauma center. J Emerg Trauma Shock [serial online] 2020 [cited 2020 Oct 30];13:232. Available from: https://www.onlinejets.org/text.asp?2020/13/3/232/295376




Dear Editor,

The “weekend effect” is a theory that purports patients who undergo surgery or hospital admission during the weekend have worse outcomes.[1] We evaluated the effect of weekend versus weekday on trauma patients undergoing emergent exploratory laparotomy at out Level 1 trauma center (TC), including intensive care unit length of stay (ICU-LOS), 30-day readmission, and injury adjusted mortality.

A 6-year review of our TC registry was conducted on all trauma patients who underwent emergency exploratory laparotomy. Patients were divided into two groups based on initial operation start time – Group-Weekday (7 am Monday–4:59 pm Friday) and Group-Weekend (5 pm Friday–6:59 am Monday).

The total number of patients was 343; Group-Weekday contained 175 patients and Group-Weekend 168. Demographics were similar between groups, including mean ISS, AIS, and mechanism (P > 0.05 for all). Outcome measures showed no significant difference between the groups when comparing ICU-LOS, and 30-day readmissions. Adjusted, all-cause observed/expected mortality also did not significantly differ between groups (Weekday = 0.80 vs. Weekend = 0.88, P > 0.05).

In this study, the “weekend effect” was not observed. Patients who underwent initial exploratory laparotomy during the weekend had a similar ICU-LOS, 30-day readmissions, and mortality compared to those during the weekday. Patient cohorts of weekend and weekday had similar demographic and injury characteristics, supporting these results. The absence of the “weekend effect,” as was observed in this study, is supported by two previous analyses for patients undergoing laparoscopic appendectomies, both of which also did not observe a “weekend effect.”[2],[3] Other studies have suggested improving emergency medical response systems, inpatient rehabilitation, pain management programs, nurse-to-bed ratios, and weekend staff wages to prevent the “weekend effect.”[4],[5]

The “weekend effect” is a theory that concerns many fields of medicine and possibly leads to poor outcomes for patients who present during the weekend. This study concluded that our TC is not prone to the “weekend effect.” TCs may serve as a model for determining surgical service characteristics that can be applied to other fields to mitigate the “weekend effect.” Future studies should expand the sample size to include multiple institutions and investigate the impact of prehospital resources, emergency departments' readiness, and hospital resources on outcomes.

The abstract leading to this paper was presented at the 2020 Academic Surgical Congress in Orlando, FL Feb 2-6, 2020.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
O'Donnell TF, Li C, Swerdlow NJ, Liang P, Pothof AB, Patel VI, et al. The weekend effect in AAA repair. Ann Surg 2019;269:1170-5.  Back to cited text no. 1
    
2.
Ferguson HJ, Hall NJ, Bhangu A, National Surgical Research Collaborative. A multicentre cohort study assessing day of week effect and outcome from emergency appendicectomy. BMJ Qual Saf 2014;23:732-40.  Back to cited text no. 2
    
3.
Worni M, Østbye T, Gandhi M, Rajgor D, Shah J, Shah A, et al. Laparoscopic appendectomy outcomes on the weekend and during the week are no different: A national study of 151,774 patients. World J Surg 2012;36:1527-33.  Back to cited text no. 3
    
4.
Kothari AN, Zapf MA, Blackwell RH, Markossian T, Chang V, Mi Z, et al. Components of hospital perioperative infrastructure can overcome the weekend effect in urgent general surgery procedures. Ann Surg 2015;262:683-91.  Back to cited text no. 4
    
5.
Kothari AN, Brownlee SA, Blackwell RH, Zapf MA, Markossian T, Gupta GN, et al. Association between elements of electronic health record systems and the weekend effect in urgent general surgery. JAMA Surg 2017;152:602-3.  Back to cited text no. 5
    

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Correspondence Address:
Adel Elkbuli
Department of Surgery, Kendall Regional Medical Center, Miami, Florida
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JETS.JETS_8_20

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