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Components of Hospital Perioperative Infrastructure Can Overcome the Weekend Effect in Urgent General Surgery Procedures

Kothari, Anai N. MD*,†; Zapf, Matthew A.C.†,§; Blackwell, Robert H. MD†,‡; Markossian, Talar PhD||; Chang, Victor†,§; Mi, Zhiyong PhD*,†; Gupta, Gopal N. MD†,‡; Kuo, Paul C. MD*,†

doi: 10.1097/SLA.0000000000001436
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Objective: We hypothesized that perioperative hospital resources could overcome the “weekend effect” (WE) in patients undergoing emergent/urgent surgeries.

Summary Background Data: The WE is the observation that surgeon-independent patient outcomes are worse on the weekend compared with weekdays. The WE is often explained by differences in staffing and resources resulting in variation in care between the week and weekend.

Methods: Emergent/urgent surgeries were identified using the Healthcare Cost and Utilization Project State Inpatient Database (Florida) from 2007 to 2011 and linked to the American Hospital Association (AHA) Annual Survey Database to determine hospital level characteristics. Extended median length of stay (LOS) on the weekend compared with the weekdays (after controlling for hospital, year, and procedure type) was selected as a surrogate for WE.

Results: Included were 126,666 patients at 166 hospitals. A total of 17 hospitals overcame the WE during the study period. Logistic regression, controlling for patient characteristics, identified full adoption of electronic medical records (OR 4.74), home health program (OR 2.37), pain management program [odds ratio (OR) 1.48)], increased registered nurse-to-bed ratio (OR 1.44), and inpatient physical rehabilitation (OR 1.03) as resources that were predictors for overcoming the WE. The prevalence of these factors in hospitals exhibiting the WE for all 5 years of the study period were compared with those hospitals that overcame the WE (P < 0.001).

Conclusions: Specific hospital resources can overcome the WE seen in urgent general surgery procedures. Improved hospital perioperative infrastructure represents an important target for overcoming disparities in surgical care.

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*Department of Surgery, Loyola University Medical Center, Maywood, IL

Department of Surgery, One: MAP Surgical Analytics Research Group, Loyola University Chicago, Maywood, IL

Department of Urology, Loyola University Medical Center, Maywood, IL

§Loyola Stritch School of Medicine, Maywood, IL

||Department of Public Health Sciences, Loyola University Chicago, Maywood, IL.

Reprints: Paul C. Kuo, MD, MS, MBA, John P., Deparment of Surgery, Loyola University Medical Center, Maywood, IL 60153. E-mail: pkuo@lumc.edu.

Disclosure: The authors report no conflicts of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (www.annalsofsurgery.com).

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