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Seasonal Variation in Emergency General Surgery

Zangbar, Bardiya MD; Rhee, Peter MD; Pandit, Viraj MD; Hsu, Chiu-Hsieh PhD; Khalil, Mazhar MD; Okeefe, Terence MB ChB; Neumayer, Leigh MD; Joseph, Bellal MD

doi: 10.1097/SLA.0000000000001238

Objective: The aim of this study was to assess the seasonal variation in emergency general surgery (EGS) admissions.

Background: Seasonal variation in medical conditions is well established; however, its impact on EGS cases remains unclear.

Methods: The National Inpatient Sample (NIS) database was queried over an 8-year period (2004–2011) for all patients with diagnosis of acute appendicitis, acute cholecystitis, and diverticulitis. Elective admissions were excluded. The following data for each admission were recorded: age, sex, race, admission month, major operative procedure, hospital region, and mortality. Seasons were defined as follows: Spring (March, April, May), Summer (June, July, August), Fall (September, October, November), and Winter (December, January, February). X11 procedure and spectral analysis were performed to confirm seasonal variation.

Results: A total of 63,911,033 admission records were evaluated of which 493,569 were appendicitis, 395,838 were cholecystitis, and 412,163 were diverticulitis. Seasonal variation is confirmed in EGS (F = 159.12, P < 0.0001) admissions. In the subanalysis, seasonal variation was found in acute appendicitis (F = 119.62, P < 0.0001), acute cholecystitis (F = 37.13, P < 0.0001), and diverticulitis (F = 69.90, P < 0.0001). The average monthly EGS admission in Winter was 11,322 ± 674. The average monthly EGS admission in Summer was higher than that of Winter by 13.6% (n = 1542; 95% CI: 1180–1904, P < 0.001).

Conclusions: Hospitalization due to EGS adheres to a consistent cyclical pattern, with more admissions occurring during the Summer months. Although the reasons for this variability are unknown, this information may be useful for hospital resource reallocation and staffing.

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Division of Trauma, Department of Surgery, University of Arizona, Tucson, AZ.

Reprints: Bellal Joseph, MD, Department of Surgery, Division of Trauma, Critical Care, and Emergency Surgery, University of Arizona, 1501 N Campbell Avenue, Room 5411, PO Box 245063, Tucson, AZ 85727. E-mail:

Disclosure: The authors have no financial or proprietary interest in the subject matter or materials discussed in the article.

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