Children receiving common urgent surgeries on the weekend face greater risks of death, blood transfusions, and surgical complications, according to a recent study.
"Our results are consistent with a growing body of evidence that mortality is overall increased during weekend hospitalizations," Dr. Seth Goldstein and his associates at Johns Hopkins University, Baltimore, reported. They noted that adult diverticulitis, stroke, pneumonia, traumatic brain injury, and ICU admissions have all also shown a "detrimental weekend effect" in past research (J. Pediatr. Surg. 2014;49:1087-91).
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Children receiving common urgent surgeries on the weekend face greater risks of death, blood transfusions, and surgical complications.
Dr. Goldstein’s team analyzed rates of death, blood transfusions, and surgical complications – including hemorrhage, accidental puncture or laceration, infections and wound-related complications – in 439,457 pediatric cases admitted to the hospital and requiring same-day procedures between 1988 and 2010.
Data on the 112,064 weekend admissions (25.5%) and 327,393 weekday admissions (74.5%) were pulled from the Nationwide Inpatient Sample and the Kid's Inpatient Database and included the following procedures: abscess drainage, appendectomy, inguinal hernia repair, open reduction with internal fixation of bone fracture, and placement or revision of ventricular shunt.
Admissions were more likely to be emergent on the weekend (60.9%) than on the weekday (52.6%), and children admitted on the weekends were slightly older and more often male, white, and uninsured but had less comorbidity when discharged. Rates of death were not statistically significant before adjustment for confounders, with deaths occurring among 0.11% of children admitted on weekdays and 0.14% of children admitted on weekends.
Preadjusted rates of blood transfusion were greater for weekend admissions (0.71%) than for weekday admissions (0.60%, P = .002), as were accidental punctures or lacerations, with 0.21% among weekend cases and 0.18% among weekday cases (P = .018). Yet wound complications were less common among children admitted on the weekend (0.11%) than on weekdays (0.13%, P = .044). Hemorrhage and wound infections did not differ between the groups before adjustment.
After adjusting for age, sex, race, insurance status, comorbidities, geographic region, hospital type (rural and urban teaching or nonteaching), admission type, and procedure type, the researchers found children admitted on the weekend had 1.63 greater odds of death than children admitted on weekdays. Children admitted on the weekend also had 1.4 times greater odds of an accidental puncture or laceration and 1.14 times greater odds of a blood transfusion, despite similar rates of hemorrhage. Wound infections and other wound-related complications did not differ between the groups after adjustment.
"We believe these findings to be predominately a result of systems issues such as decreased availability of staff and other hospital resources that contribute to patient care in a manner that is multifactorial and difficult to individually ascertain," the researchers wrote.
"While the exact etiology of these findings is not clear, these findings motivate a careful search for systems-based deficiencies that may be a detriment to pediatric surgical care provided on the weekend," they wrote.
With regard to mortality, the researchers wrote, "The mortality associated with pediatric surgical procedures is generally very low, requiring the large patient numbers included in these cohorts to detect potential differences. As an illustration, the significant adjusted odds ratio for mortality of 1.63 represents an increase in actual unadjusted death rate of only 0.03% (0.14% from 0.11%)." Nonetheless, they estimated that reducing weekend mortality rates to those of weekdays would have prevented the deaths of approximately 30 patients during the study period, a 20% reduction of inpatient deaths.
The study was internally funded, and the authors had no disclosures.