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Laparoscopic Appendectomy Outcomes on the Weekend and During the Week are no Different: A National Study of 151,774 Patients

Worni, Mathias ; Østbye, Truls ; Gandhi, Mihir ; Rajgor, Dimple ; Shah, Jatin ; Shah, Anand ; Pietrobon, Ricardo ; Jacobs, Danny ; Guller, Ulrich

In: World Journal of Surgery, 2012, vol. 36, no. 7, p. 1527-1533

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    Titel
    • Laparoscopic Appendectomy Outcomes on the Weekend and During the Week are no Different: A National Study of 151,774 Patients
    Autor
    • Worni, Mathias. Research on Research Group, Department of Surgery, Duke University Medical Center, Durham, NC, USA
    • Østbye, Truls. Department of Community and Family Medicine, Duke University Medical Center, Durham, NC, USA
    • Gandhi, Mihir. Research on Research Group, Department of Surgery, Duke University Medical Center, Durham, NC, USA
    • Rajgor, Dimple. Research on Research Group, Department of Surgery, Duke University Medical Center, Durham, NC, USA
    • Shah, Jatin. Research on Research Group, Department of Surgery, Duke University Medical Center, Durham, NC, USA
    • Shah, Anand. Research on Research Group, Department of Surgery, Duke University Medical Center, Durham, NC, USA
    • Pietrobon, Ricardo. Research on Research Group, Department of Surgery, Duke University Medical Center, Durham, NC, USA
    • Jacobs, Danny. Department of Surgery, Duke University Medical Center, Durham, NC, USA
    • Guller, Ulrich. Department of Visceral Surgery and Medicine, Inselspital, Berne University Hospital, 3010, Berne, Switzerland
    Dokumententyp
    • Postprint
    Sprache
    • Englisch
    Veröffentlicht in
    • World Journal of Surgery, 2012, vol. 36, no. 7, p. 1527-1533. Springer-Verlag
    Andere elektronische Ausgabe
    Klassifikation
    • Gesundheit
    OAI-PMH-ID
    • oai:doc.rero.ch:314646
    Summary
    Background: The "weekend effect” is defined as increased morbidity and mortality for patients admitted on weekends compared with weekdays. It has been observed for several diseases, including myocardial infarction and renal insufficiency; however, it has not yet been investigated for laparoscopic appendectomy in acute appendicitis—one of the most prevalent surgical diagnoses. Methods: The present study is based on the Nationwide Inpatient Sample (NIS) from 1999 to 2008. The following outcomes were compared between patients undergoing laparoscopic appendectomy for acute appendicitis admitted on weekdays versus weekends: severity of appendicitis, intraoperative and postoperative complications, conversion rate, in-hospital mortality, and length of hospital stay. Unadjusted and risk-adjusted generalized linear regression analyses were performed. Results: Overall, 151,774 patients were included, mean age was 39.6years, 52.6% (n=79,801) were male, and 25.3% (n=38,317) were admitted on weekends. After risk adjustment, the conversion rate was lower [odds ratio (OR): 0.94, p=0.004, number needed to harm (NNH): 244], whereas pulmonary complications (OR: 1.12, p=0.028, NNH: 649) and reoperations (OR: 1.21, p=0.013, NNH: 1,028) were slightly higher on weekends than on weekdays. Overall postoperative complications (OR: 1.03, p=0.24), mortality (OR: 1.37, p=0.075) and length of hospital stay (mean on weekday: 2.00days, weekends: 2.01days, p=0.29) were not statistically different. Conclusions: The present investigation provides evidence that no clinically significant "weekend effect” for patients undergoing laparoscopic appendectomy exists. Therefore, hospital or staffing policy changes are not justified based on the findings from this large national study