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Kim S, Selya AS. Weekend delivery and maternal-neonatal adverse outcomes in low-risk pregnancies in the United States: A population-based analysis of 3-million live births. Birth 2022; 49:549-558. [PMID: 35233821 DOI: 10.1111/birt.12626] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 06/17/2020] [Accepted: 02/07/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Childbirth is the most common cause of hospital admission in the United States. Previous studies have shown that there might be a "weekend effect" in perinatal care, indicating that mothers and newborns whose deliveries occur during the weekends are at increased risk of having adverse outcomes. This study aims to isolate the association between the weekend delivery and maternal-neonatal adverse outcomes by investigating low-risk pregnancies in nationwide data. METHODS A population-based study of all low-risk pregnancies (in-hospital, nonanomalous, term, normal birthweight, and singleton) was conducted based on US national natality data in 2017. Four maternal outcomes (ICU admission, uterine rupture, blood transfusion, and perineal laceration) and three neonatal outcomes (5-minute Apgar <7, NICU admission, and neonatal death) were defined as adverse outcomes. Logistic regression analyses were conducted to determine the association, adjusting for 23 maternal and neonatal characteristics and risk factors. RESULTS Among 3 011 577 low-risk pregnancies, 6.0% were reported to have at least one of the maternal-neonatal adverse outcomes. Weekend deliveries were significantly associated with six maternal-neonatal adverse outcomes with an exception of neonatal death. In general, weekend deliveries were 1.13 times significantly as likely to have any of seven maternal-neonatal adverse outcomes than weekday deliveries (OR 1.13, 95% CI 1.11-1.14), being attributed to adverse outcomes of more than 4500 mother-newborn pairs. CONCLUSIONS Weekend delivery is a consistent risk factor for both mothers and babies at the national level. Furthermore, studies are needed about possible modifiable factors that mediate these associations to ensure safe childbirth regardless of the day of delivery.
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Affiliation(s)
- Sooyong Kim
- Department of Population Health, University of North Dakota School of Medicine & Health Sciences, Grand Forks, North Dakota, USA
| | - Arielle S Selya
- Department of Population Health, University of North Dakota School of Medicine & Health Sciences, Grand Forks, North Dakota, USA.,Behavioral Sciences Group, Sanford Research, Sioux Falls, South Dakota, USA.,Department of Pediatrics, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota, USA
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Bion J, Aldridge C, Beet C, Boyal A, Chen YF, Clancy M, Girling A, Hofer T, Lord J, Mannion R, Rees P, Roseveare C, Rowan L, Rudge G, Sun J, Sutton E, Tarrant C, Temple M, Watson S, Willars J, Lilford R. Increasing specialist intensity at weekends to improve outcomes for patients undergoing emergency hospital admission: the HiSLAC two-phase mixed-methods study. HEALTH SERVICES AND DELIVERY RESEARCH 2021. [DOI: 10.3310/hsdr09130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background
NHS England’s 7-day services policy comprised 10 standards to improve access to quality health care across all days of the week. Six standards targeted hospital specialists on the assumption that their absence caused the higher mortality associated with weekend hospital admission: the ‘weekend effect’. The High-intensity Specialist-Led Acute Care (HiSLAC) collaboration investigated this using the implementation of 7-day services as a ‘natural experiment’.
Objectives
The objectives were to determine whether or not increasing specialist intensity at weekends improves outcomes for patients undergoing emergency hospital admission, and to explore mechanisms and cost-effectiveness.
Design
This was a two-phase mixed-methods observational study. Year 1 focused on developing the methodology. Years 2–5 included longitudinal research using quantitative and qualitative methods, and health economics.
Methods
A Bayesian systematic literature review from 2000 to 2017 quantified the weekend effect. Specialist intensity measured over 5 years used self-reported annual point prevalence surveys of all specialists in English acute hospital trusts, expressed as the weekend-to-weekday ratio of specialist hours per 10 emergency admissions. Hospital Episode Statistics from 2007 to 2018 provided trends in weekend-to-weekday mortality ratios. Mechanisms for the weekend effect were explored qualitatively through focus groups and on-site observations by qualitative researchers, and a two-epoch case record review across 20 trusts. Case-mix differences were examined in a single trust. Health economics modelling estimated costs and outcomes associated with increased specialist provision.
Results
Of 141 acute trusts, 115 submitted data to the survey, and 20 contributed 4000 case records for review and participated in qualitative research (involving interviews, and observations using elements of an ethnographic approach). Emergency department attendances and admissions have increased every year, outstripping the increase in specialist numbers; numbers of beds and lengths of stay have decreased. The reduction in mortality has plateaued; the proportion of patients dying after discharge from hospital has increased. Specialist hours increased between 2012/13 and 2017/18. Weekend specialist intensity is half that of weekdays, but there is no relationship with admission mortality. Patients admitted on weekends are sicker (they have more comorbid disease and more of them require palliative care); adjustment for severity of acute illness annuls the weekend effect. In-hospital care processes are slightly more efficient at weekends; care quality (errors, adverse events, global quality) is as good at weekends as on weekdays and has improved with time. Qualitative researcher assessments of hospital weekend quality concurred with case record reviewers at trust level. General practitioner referrals at weekends are one-third of those during weekdays and have declined further with time.
Limitations
Observational research, variable survey response rates and subjective assessments of care quality were compensated for by using a difference-in-difference analysis over time.
Conclusions
Hospital care is improving. The weekend effect is associated with factors in the community that precede hospital admission. Post-discharge mortality is increasing. Policy-makers should focus their efforts on improving acute and emergency care on a ‘whole-system’ 7-day approach that integrates social, community and secondary health care.
Future work
Future work should evaluate the role of doctors in hospital and community emergency care and investigate pathways to emergency admission and quality of care following hospital discharge.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 13. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Julian Bion
- University Department of Anaesthesia & Critical Care, University of Birmingham, Birmingham, UK
| | - Cassie Aldridge
- University Department of Anaesthesia & Critical Care, University of Birmingham, Birmingham, UK
| | - Chris Beet
- Intensive Care Medicine, Royal Derby Hospital NHS Trust, Derby, UK
| | - Amunpreet Boyal
- Research & Development, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Yen-Fu Chen
- Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Michael Clancy
- Emergency Medicine, University of Southampton, Southampton, UK
| | - Alan Girling
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Timothy Hofer
- Institute for Health Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Joanne Lord
- Southampton Health Technology Assessments Centre, University of Southampton, Southampton, UK
| | - Russell Mannion
- Health Services Management Centre, University of Birmingham, Birmingham, UK
| | - Peter Rees
- Patient & Lay Committee, Academy of Medical Royal Colleges, London, UK
| | - Chris Roseveare
- General Internal Medicine, Southern Health NHS Foundation Trust, Southampton, UK
| | - Louise Rowan
- University Department of Anaesthesia & Critical Care, University of Birmingham, Birmingham, UK
| | - Gavin Rudge
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Jianxia Sun
- Informatics, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | | | | | - Mark Temple
- Nephrology, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Sam Watson
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Janet Willars
- Health Sciences, University of Leicester, Leicester, UK
| | - Richard Lilford
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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Carter EH, Lee HC, Lapcharoensap W, Snowden JM. Resuscitation outcomes for weekend deliveries of very low birthweight infants. Arch Dis Child Fetal Neonatal Ed 2020; 105:656-661. [PMID: 32414815 DOI: 10.1136/archdischild-2019-317807] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 04/14/2020] [Accepted: 04/16/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To characterise the association between weekend (Saturday and Sunday) deliveries of very low birthweight (VLBW) infants and delivery room outcomes in the 'golden hour' after birth. DESIGN AND SETTING A retrospective cohort study using California Perinatal Quality Care Collaborative data from participating neonatal intensive care units. PATIENTS The study population after exclusions was 26 515 VLBW infants born in California from 2010 to 2016. MAIN OUTCOME MEASURES Delivery room outcomes assessed included: chest compressions, epinephrine, intubation prior to continuous positive airway pressure ventilation, 5 min Apgar <4, admission hypothermia and death within 12 hours. To adjust for potential confounders, we fit multivariate regression models controlling for two sets of infant, maternal and hospital characteristics. RESULTS Infants delivered on weekends were less likely to have been prenatally diagnosed with intrauterine growth restriction but were otherwise not significantly different in gestational age, ethnicity, sex or maternal risk factors than those born during weekdays. Caesarean deliveries were less common on weekends, while vaginal deliveries were consistent across all days. After adjusting for sex and race, weekend delivery was associated with delivery room chest compressions (OR: 1.12, 95% CI 1.02 to 1.24) and lower 5 min Apgar (OR: 1.11, 95% CI 1.01 to 1.21). CONCLUSION In this population-based study of VLBW infants, there was an increase in chest compressions for infants born on the weekend. More research is needed on the differences between populations born on weekdays versus weekends, and how these may contribute to observed associations.
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Affiliation(s)
- Emily Hawkins Carter
- Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, USA
| | - Henry C Lee
- Department of Pediatrics, Stanford University, Stanford, California, USA
| | | | - Jonathan M Snowden
- Department of Obstetrics & Gynecology/Public Health & Preventive Medicine, Oregon Health & Science University, Portland, Oregon, USA
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Eze P, Lawani LO, Ukaegbe CI, Anozie OB, Iyoke CA. Association between time of delivery and poor perinatal outcomes -An evaluation of deliveries in a tertiary hospital, South-east Nigeria. PLoS One 2019; 14:e0217943. [PMID: 31181101 PMCID: PMC6557521 DOI: 10.1371/journal.pone.0217943] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 05/21/2019] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Nigeria account for a significant proportion of adverse perinatal outcome. Nigerian studies assessing impact of time of delivery on perinatal outcome are scarce. This study evaluates any associations between time of delivery and perinatal outcome. METHODS This was a cross-sectional study at the Federal Teaching Hospital, Abakaliki from 01 January 2016 to 30 June 2018. Data were analysed with IBM SPSS version 25.0. RESULTS A total of 4,556 deliveries were analysed. Majority (72.2%) delivered on week days and 27.8% on weekends. Over 90% had 1st and 5th minutes Apgar scores ≥7. There was statistical difference in NICU admission between morning and evening hours (p = 0.009) but not between morning and night hours (p = 0.795). ENND during evening was twice higher (1.2%) than morning (0.5%); p = 0.047 and night hours (0.6%); p = 0.623.There was no difference in the risk of fresh stillbirths between morning and evening (p = 0.560), as well as morning and night hours (p = 0.75), there was also no difference in fresh stillbirths between week days and weekends (p = 0.895). There was no difference in low Apgar scores at 1st minute between morning and evening (p = 0.053) and night (p = 0.221), and between weekdays and weekends (p = 0.524). Similarly, there was no difference in low 5th minute Apgar scores between morning and evening (p = 0.165) and night (p = 0.944), as well as between week days and weekends (p = 0.529). However, ENND was twice (p = 0.085) and 1.3 times higher (p = 0.526) for evening and night hours respectively, while there was no difference between weekends and week days (p = 0.652). CONCLUSION NICU admission and ENND were commoner during evening hours. However, work hours did not affect the rate of stillbirth and low Apgar scores during weekdays and weekends. It is pertinent for each obstetric unit to identify and modify factors responsible for unfavourable outcomes during various shifts, with the aim of improving perinatal health.
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Affiliation(s)
- Paul Eze
- Medicins Sans Frontieres (MSF), OCBA, Barcelona, Spain
| | - Lucky Osaheni Lawani
- Department of Obstetrics & Gynecology, Federal Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
- * E-mail:
| | | | | | - Chukwuemeka Anthony Iyoke
- Department of Obstetrics & Gynecology, University of Nigeria Teaching Hospital, Enugu, Enugu State, Nigeria
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Chen YF, Armoiry X, Higenbottam C, Cowley N, Basra R, Watson SI, Tarrant C, Boyal A, Sutton E, Wu CW, Aldridge CP, Gosling A, Lilford R, Bion J. Magnitude and modifiers of the weekend effect in hospital admissions: a systematic review and meta-analysis. BMJ Open 2019; 9:e025764. [PMID: 31164363 PMCID: PMC6561443 DOI: 10.1136/bmjopen-2018-025764] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 03/14/2019] [Accepted: 04/15/2019] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To examine the magnitude of the weekend effect, defined as differences in patient outcomes between weekend and weekday hospital admissions, and factors influencing it. DESIGN A systematic review incorporating Bayesian meta-analyses and meta-regression. DATA SOURCES We searched seven databases including MEDLINE and EMBASE from January 2000 to April 2015, and updated the MEDLINE search up to November 2017. Eligibility criteria: primary research studies published in peer-reviewed journals of unselected admissions (not focusing on specific conditions) investigating the weekend effect on mortality, adverse events, length of hospital stay (LoS) or patient satisfaction. RESULTS For the systematic review, we included 68 studies (70 articles) covering over 640 million admissions. Of these, two-thirds were conducted in the UK (n=24) or USA (n=22). The pooled odds ratio (OR) for weekend mortality effect across admission types was 1.16 (95% credible interval 1.10 to 1.23). The weekend effect appeared greater for elective (1.70, 1.08 to 2.52) than emergency (1.11, 1.06 to 1.16) or maternity (1.06, 0.89 to 1.29) admissions. Further examination of the literature shows that these estimates are influenced by methodological, clinical and service factors: at weekends, fewer patients are admitted to hospital, those who are admitted are more severely ill and there are differences in care pathways before and after admission. Evidence regarding the weekend effect on adverse events and LoS is weak and inconsistent, and that on patient satisfaction is sparse. The overall quality of evidence for inferring weekend/weekday difference in hospital care quality from the observed weekend effect was rated as 'very low' based on the Grading of Recommendations, Assessment, Development and Evaluations framework. CONCLUSIONS The weekend effect is unlikely to have a single cause, or to be a reliable indicator of care quality at weekends. Further work should focus on underlying mechanisms and examine care processes in both hospital and community. PROSPERO REGISTRATION NUMBER CRD42016036487.
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Affiliation(s)
- Yen-Fu Chen
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Xavier Armoiry
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Nicholas Cowley
- Worcestershire Acute Hospitals NHS Trust, Worcester, Worcestershire, UK
| | - Ranjna Basra
- University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, Staffordshire, UK
| | - Samuel Ian Watson
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Carolyn Tarrant
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Amunpreet Boyal
- University Department of Anaesthesia & Critical Care, Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Elizabeth Sutton
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Chia-Wei Wu
- National Taiwan University Hospital, Taipei, Taiwan
| | - Cassie P Aldridge
- University Department of Anaesthesia & Critical Care, Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Amy Gosling
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Richard Lilford
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Julian Bion
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- University Department of Anaesthesia & Critical Care, Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
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Nageswaran H, Rajalingam V, Sharma A, Joseph AO, Davies M, Jones H, Evans M. Mortality for emergency laparotomy is not affected by the weekend effect: a multicentre study. Ann R Coll Surg Engl 2019; 101:366-372. [PMID: 31042429 PMCID: PMC6513362 DOI: 10.1308/rcsann.2019.0037] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2019] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The 'weekend effect' describes variation in outcomes of patients treated over the weekend compared with those treated during weekdays. This study examines whether a weekend effect exists for patients who undergo emergency laparotomy. MATERIALS AND METHODS Data entered into the National Emergency Laparotomy Audit between 2014 and 2017 at four NHS trusts in England and Wales were analysed. Patients were grouped into those admitted on weekdays and those on weekends (Friday 5pm to Monday 8am). Patient factors, markers of quality of care and patient outcomes were compared. Secondary analysis was performed according to the day of surgery. RESULTS After exclusion of patients who underwent laparotomy more than one week after admission to hospital, a total of 1717 patients (1138 patients admitted on weekdays and 579 admitted on weekends) were analysed. Age, preoperative lactate and P-POSSUM scores were not significantly different between the two groups. Time from admission to consultant review, decision to operate, commencement of antibiotics and theatre were not significantly different. Grades of operating surgeon were also similar in both groups. Inpatient 60-day mortality was 12.5% on weekdays and 12.8% on weekends (P = 0.878). Median length of postoperative stay was 12 days in both groups. When analysed according to day of surgery, only number of hours from admission to antibiotics (12.8 weekday vs 9.4 weekend, P = 0.046) and number of hours to theatre (26.5 weekday vs 24.1 hours weekend, P = 0.020) were significantly different. DISCUSSION Quality of care and clinical outcomes for patients undergoing emergency laparotomy during the weekend are not significantly different to those carried out during weekdays.
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Affiliation(s)
- H Nageswaran
- Morriston Hospital, Heol Maes Eglwys, Morriston, Swansea, UK
| | - V Rajalingam
- Queen Elizabeth Hospital, Mindelsohn Way, Birmingham, UK
| | - A Sharma
- Conquest Hospital, The Ridge, Hastings, Saint Leonards-on-sea, UK
| | - AO Joseph
- Southend University Hospital, Prittwell Chase, Westfliff-on-Sea, Essex, UK
| | - M Davies
- Morriston Hospital, Heol Maes Eglwys, Morriston, Swansea, UK
| | - H Jones
- Morriston Hospital, Heol Maes Eglwys, Morriston, Swansea, UK
| | - M Evans
- Morriston Hospital, Heol Maes Eglwys, Morriston, Swansea, UK
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García‐Muñoz Rodrigo F, García Cruz L, Galán Henríquez G, Urquía Martí L, Rivero Rodríguez S, García‐Alix A, Figueras Aloy J. Variations in the number of births by day of the week, and morbidity and mortality in very‐low‐birth‐weight infants. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2019. [DOI: 10.1016/j.jpedp.2017.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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8
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García-Muñoz Rodrigo F, García Cruz L, Galán Henríquez G, Urquía Martí L, Rivero Rodríguez S, García-Alix A, Figueras Aloy J. Variations in the number of births by day of the week, and morbidity and mortality in very-low-birth-weight infants. J Pediatr (Rio J) 2019; 95:41-47. [PMID: 29197224 DOI: 10.1016/j.jped.2017.10.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 10/05/2017] [Accepted: 10/05/2017] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To know the distribution of births of very low birth weight infants by day of the week, and whether this distribution affects the morbidity and mortality in this group of patients. METHODS This was a retrospective analysis of data collected prospectively in the Spanish SEN1500 network (2002-2011). Outborn infants, patients with major congenital anomalies, and those who died in the delivery room were excluded. Births were grouped into "weekdays" and "weekends." A multivariate logistic regression analysis was conducted to evaluate the independent effect of the birth moment on outcomes, and Cox regression for survival. RESULTS Out of a total of 27,205 very low birth weight infants born at and/or admitted to the participating centers, 22,961 (84.4%) met inclusion criteria. A reduction of 24% in the number of births was observed during the "weekends" compared with "weekdays". In the raw analysis, patients born on weekends exhibited higher morbidity and mortality (mortality rate: 14.2% vs. 16.5%, p<0.001), but differences were no longer significant after adjusting for confounding factors. CONCLUSIONS The present results suggest that current care practices reduce the proportion of births during the weekends and tend to cluster some high-risk births during this period, increasing crude morbidity and mortality. However, after adjusting for confounding factors, the differences disappear, suggesting that overall care coverage in these centers is appropriate.
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Affiliation(s)
- Fermín García-Muñoz Rodrigo
- Complejo Hospitalario Universitario Insular Materno-Infantil de Las Palmas de Gran Canaria, Unidad Neonatal, Las Palmas, Spain.
| | - Loida García Cruz
- Complejo Hospitalario Universitario Insular Materno-Infantil de Las Palmas de Gran Canaria, Unidad Neonatal, Las Palmas, Spain
| | - Gloria Galán Henríquez
- Complejo Hospitalario Universitario Insular Materno-Infantil de Las Palmas de Gran Canaria, Unidad Neonatal, Las Palmas, Spain
| | - Lourdes Urquía Martí
- Complejo Hospitalario Universitario Insular Materno-Infantil de Las Palmas de Gran Canaria, Unidad Neonatal, Las Palmas, Spain
| | - Sonia Rivero Rodríguez
- Complejo Hospitalario Universitario Insular Materno-Infantil de Las Palmas de Gran Canaria, Unidad Neonatal, Las Palmas, Spain
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Jehan F, Khan M, Kulvatunyou N, Hamidi M, Gries L, Zeeshan M, O'Keeffe T, Joseph B. Day of Hospital Admission and Effect on Outcomes: The Weekend Effect in Acute Gallstone Pancreatitis. J Surg Res 2018; 233:192-198. [PMID: 30502247 DOI: 10.1016/j.jss.2018.07.070] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 07/12/2018] [Accepted: 07/19/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND The aim of our study was to evaluate outcomes in patients who are admitted on weekend compared with those admitted on a weekday for acute gallstone pancreatitis. METHODS We performed a 3-y (2010-2012) analysis of the Nationwide Inpatient Sample database. Patients with acute gallstone pancreatitis who underwent endoscopic retrograde cholangiopancreatography (ERCP) were included and were divided into two groups: admission on the weekend versus the weekday. Primary outcome measures were time to ERCP, adverse events, and mortality. Secondary outcome measures were hospital length of stay and total cost. RESULTS A total of 5803 patients with acute gallstone pancreatitis who underwent ERCP were included in our study; of which 22.6% were admitted on the weekend, whereas 77.4% were admitted on a weekday. Mean age was 57 ± 18 y and 57.1% were female. Within 24 h, the rate of ERCP was higher in patients admitted on the weekday compared with those admitted on the weekend (40% versus 24%; P < 0.001). Similarly, by 48 h, the rate of ERCP was higher in the weekday group (69% versus 49%, P < 0.001). Patients admitted over the weekends had higher complications rate (P = 0.03), hospital length of stay (P < 0.001), and the total cost of hospitalization (P < 0.001) compared with the weekday group with no difference in in-hospital mortality. CONCLUSIONS Patients admitted on weekends for acute gallstone pancreatitis experience a delay in getting ERCP and have higher complications, prolonged hospital stay, and increased hospital costs compared with those admitted on weekdays.
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Affiliation(s)
- Faisal Jehan
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona
| | - Muhammad Khan
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona
| | - Narong Kulvatunyou
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona
| | - Mohammad Hamidi
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona
| | - Lynn Gries
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona
| | - Muhammad Zeeshan
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona
| | - Terence O'Keeffe
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona
| | - Bellal Joseph
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona.
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Vedantam A, Hansen D, Briceño V, Moreno A, Ryan SL, Jea A. Interhospital transfer of pediatric neurosurgical patients. J Neurosurg Pediatr 2016; 18:638-643. [PMID: 27447345 DOI: 10.3171/2016.5.peds16155] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE The purpose of this study was to describe patterns of transfer, resource utilization, and clinical outcomes associated with the interhospital transfer of pediatric neurosurgical patients. METHODS All consecutive, prospectively collected requests for interhospital patient transfer to the pediatric neurosurgical service at Texas Children's Hospital were retrospectively analyzed from October 2013 to September 2014. Demographic patient information, resource utilization, and outcomes were recorded and compared across predefined strata (low [< 5%], moderate [5%-30%], and high [> 30%]) of predicted probability of mortality using the Pediatric Risk of Mortality score. RESULTS Requests for pediatric neurosurgical care comprised 400 (3.7%) of a total of 10,833 calls. Of 400 transfer admissions, 96.5%, 2.8%, and 0.8% were in the low, moderate, and high mortality risk groups, respectively. The median age was 54 months, and 45% were female. The median transit time was 125 minutes. The majority of transfers were after-hours (69.8%); nearly a third occurred during the weekend (32.3%). The median intensive care unit stay for 103 patients was 3 days (range 1-269 days). Median length of hospital stay was 2 days (range 1-269 days). Ninety patients (22.5%) were discharged from the emergency room after transfer. Seventy-seven patients (19.3%) required neurosurgical intervention after transfer, with the majority requiring a cranial procedure (66.2%); 87.3% of patients were discharged home. CONCLUSIONS This study highlights patient characteristics, resource utilization, and outcomes among pediatric neurosurgical patients. Opportunities for quality improvement were identified in diagnosing and managing isolated skull fractures and neck pain after trauma.
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Affiliation(s)
- Aditya Vedantam
- Division of Pediatric Neurosurgery, Texas Children's Hospital, Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Daniel Hansen
- Division of Pediatric Neurosurgery, Texas Children's Hospital, Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Valentina Briceño
- Division of Pediatric Neurosurgery, Texas Children's Hospital, Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Amee Moreno
- Division of Pediatric Neurosurgery, Texas Children's Hospital, Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Sheila L Ryan
- Division of Pediatric Neurosurgery, Texas Children's Hospital, Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Andrew Jea
- Division of Pediatric Neurosurgery, Texas Children's Hospital, Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
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Desai V, Gonda D, Ryan SL, Briceño V, Lam SK, Luerssen TG, Syed SH, Jea A. The effect of weekend and after-hours surgery on morbidity and mortality rates in pediatric neurosurgery patients. J Neurosurg Pediatr 2015; 16:726-31. [PMID: 26406160 DOI: 10.3171/2015.6.peds15184] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Several studies have indicated that the 30-day morbidity and mortality risks are higher among pediatric and adult patients who are admitted on the weekends. This "weekend effect" has been observed among patients admitted with and for a variety of diagnoses and procedures, including myocardial infarction, pulmonary embolism, ruptured abdominal aortic aneurysm, stroke, peptic ulcer disease, and pediatric surgery. In this study, morbidity and mortality outcomes for emergency pediatric neurosurgical procedures carried out on the weekend or after hours are compared with emergency surgical procedures performed during regular weekday business hours. METHODS A retrospective analysis of operative data was conducted. Between December 1, 2011, and August 20, 2014, a total of 710 urgent or emergency neurosurgical procedures were performed at Texas Children's Hospital in children younger than than 18 years of age. These procedures were then stratified into 3 groups: weekday regular hours, weekday after hours, and weekend hours. By cross-referencing these events with a prospectively collected morbidity and mortality database, the impact of the day and time on complication incidence was examined. Outcome metrics were compared using logistic regression models. RESULTS The weekday regular hours and after-hours (weekday after hours and weekends) surgery groups consisted of 341 and 239 patients and 434 and 276 procedures, respectively. There were no significant differences in the types of cases performed (p = 0.629) or baseline preoperative health status as determined by American Society of Anesthesiologists classifications (p = 0.220) between the 2 cohorts. After multivariate adjustment and regression, children undergoing emergency neurosurgical procedures during weekday after hours or weekends were more likely to experience complications (p = 0.0227). CONCLUSIONS Weekday after-hours and weekend emergency pediatric neurosurgical procedures are associated with significantly increased 30-day morbidity and mortality risk compared with procedures performed during weekday regular hours.
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Affiliation(s)
- Virendra Desai
- Division of Pediatric Neurosurgery, Texas Children's Hospital, Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - David Gonda
- Division of Pediatric Neurosurgery, Texas Children's Hospital, Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Sheila L Ryan
- Division of Pediatric Neurosurgery, Texas Children's Hospital, Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Valentina Briceño
- Division of Pediatric Neurosurgery, Texas Children's Hospital, Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Sandi K Lam
- Division of Pediatric Neurosurgery, Texas Children's Hospital, Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Thomas G Luerssen
- Division of Pediatric Neurosurgery, Texas Children's Hospital, Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Sohail H Syed
- Division of Pediatric Neurosurgery, Texas Children's Hospital, Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Andrew Jea
- Division of Pediatric Neurosurgery, Texas Children's Hospital, Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
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Zapf MAC, Kothari AN, Markossian T, Gupta GN, Blackwell RH, Wai PY, Weber CE, Driver J, Kuo PC. The "weekend effect" in urgent general operative procedures. Surgery 2015; 158:508-14. [PMID: 26013983 DOI: 10.1016/j.surg.2015.02.024] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Revised: 02/07/2015] [Accepted: 02/10/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND There is growing concern that the quality of inpatient care may differ on weekends versus weekdays. We assessed the "weekend effect" in common urgent general operative procedures. METHODS The Healthcare Cost and Utilization Project Florida State Inpatient Database (2007-2010) was queried to identify inpatient stays with urgent or emergent admissions and surgery on the same day. Included were patients undergoing appendectomy, cholecystectomy for acute cholecystitis, and hernia repair for obstructed/gangrenous hernia. Outcomes included duration of stay, inpatient mortality, hospital-adjusted charges, and postoperative complications. Controlling for hospital and patient characteristics and type of surgery, we used multilevel mixed-effects regression modeling to examine associations between patient outcomes and admissions day (weekend vs weekday). RESULTS A total of 80,861 same-day surgeries were identified, of which 19,078 (23.6%) occurred during the weekend. Patients operated on during the weekend had greater charges by $185 (P < .05), rates of wound complications (odds ratio [OR] 1.29, 95% confidence interval [95% CI] 1.05-1.58; P < .05), and urinary tract infection (OR 1.39, 95% CI 1.05-1.85; P < .05). Patients undergoing appendectomy had greater rates of transfusion (OR 1.43, 95% CI 1.09-1.87; P = .01), wound complications (OR 1.32, 95% CI 1.04-1.68; P < .05), urinary tract infection (OR 1.76, 95% CI 1.17-2.67; P < .01), and pneumonia (OR 1.41, 95% CI 1.05-1.88; P < .05). Patients undergoing cholecystectomy had a greater duration of stay (P = .001) and greater charges (P = .003). CONCLUSION Patients undergoing weekend surgery for common, urgent general operations are at risk for increased postoperative complications, duration of stay, and hospital charges. Because the cause of the "weekend effect" is still unknown, future studies should focus on elucidating the characteristics that may overcome this disparity.
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Affiliation(s)
- Matthew A C Zapf
- Department of Surgery, Loyola University Medical Center, Maywood, IL; 1:MAP Analytics Research Group, Maywood, IL
| | - Anai N Kothari
- Department of Surgery, Loyola University Medical Center, Maywood, IL; 1:MAP Analytics Research Group, Maywood, IL
| | - Talar Markossian
- Department of Public Health Sciences, Loyola University Chicago Stritch School of Medicine, Maywood, IL
| | - Gopal N Gupta
- Department of Surgery, Loyola University Medical Center, Maywood, IL; 1:MAP Analytics Research Group, Maywood, IL
| | - Robert H Blackwell
- Department of Surgery, Loyola University Medical Center, Maywood, IL; 1:MAP Analytics Research Group, Maywood, IL
| | - Phillip Y Wai
- Department of Surgery, Loyola University Medical Center, Maywood, IL
| | - Cynthia E Weber
- Department of Surgery, Loyola University Medical Center, Maywood, IL
| | - Joseph Driver
- Department of Surgery, Loyola University Medical Center, Maywood, IL
| | - Paul C Kuo
- Department of Surgery, Loyola University Medical Center, Maywood, IL; 1:MAP Analytics Research Group, Maywood, IL.
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Goldstein SD, Papandria DJ, Aboagye J, Salazar JH, Van Arendonk K, Al-Omar K, Ortega G, Sacco Casamassima MG, Abdullah F. The "weekend effect" in pediatric surgery - increased mortality for children undergoing urgent surgery during the weekend. J Pediatr Surg 2014; 49:1087-91. [PMID: 24952794 DOI: 10.1016/j.jpedsurg.2014.01.001] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Revised: 01/05/2014] [Accepted: 01/11/2014] [Indexed: 12/26/2022]
Abstract
BACKGROUND For a number of pediatric and adult conditions, morbidity and mortality are increased when patients present to the hospital on a weekend compared to weekdays. The objective of this study was to compare pediatric surgical outcomes following weekend versus weekday procedures. METHODS Using the Nationwide Inpatient Sample and the Kids' Inpatient Database, we identified 439,457 pediatric (<18 years old) admissions from 1988 to 2010 that required a selected index surgical procedure (abscess drainage, appendectomy, inguinal hernia repair, open fracture reduction with internal fixation, or placement/revision of ventricular shunt) on the same day of admission. Outcome metrics were compared using logistic regression models that adjusted for patient and hospital characteristics as well as procedure performed. RESULTS Patient characteristics of those admitted on the weekend (n=112,064) and weekday (n=327,393) were similar, though patients admitted on the weekend were more likely to be coded as emergent (61% versus 53%). After multivariate adjustment and regression, patients undergoing a weekend procedure were more likely to die (OR 1.63, 95% CI 1.21-2.20), receive a blood transfusion despite similar rates of intraoperative hemorrhage (OR 1.15, 95% CI 1.01-1.26), and suffer from procedural complications (OR 1.40, 95% CI 1.14-1.74). CONCLUSION Pediatric patients undergoing common urgent surgical procedures during a weekend admission have a higher adjusted risk of death, blood transfusion, and procedural complications. While the exact etiology of these findings is not clear, the timing of surgical procedures should be considered in the context of systems-based deficiencies that may be detrimental to pediatric surgical care.
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Affiliation(s)
- Seth D Goldstein
- Center for Pediatric Surgical Clinical Trials & Outcomes Research, Division of Pediatric Surgery, Johns Hopkins University School of Medicine.
| | - Dominic J Papandria
- Center for Pediatric Surgical Clinical Trials & Outcomes Research, Division of Pediatric Surgery, Johns Hopkins University School of Medicine
| | - Jonathan Aboagye
- Center for Pediatric Surgical Clinical Trials & Outcomes Research, Division of Pediatric Surgery, Johns Hopkins University School of Medicine
| | - Jose H Salazar
- Center for Pediatric Surgical Clinical Trials & Outcomes Research, Division of Pediatric Surgery, Johns Hopkins University School of Medicine
| | - Kyle Van Arendonk
- Center for Pediatric Surgical Clinical Trials & Outcomes Research, Division of Pediatric Surgery, Johns Hopkins University School of Medicine
| | - Khaled Al-Omar
- Center for Pediatric Surgical Clinical Trials & Outcomes Research, Division of Pediatric Surgery, Johns Hopkins University School of Medicine
| | - Gezzer Ortega
- Center for Pediatric Surgical Clinical Trials & Outcomes Research, Division of Pediatric Surgery, Johns Hopkins University School of Medicine
| | - Maria Grazia Sacco Casamassima
- Center for Pediatric Surgical Clinical Trials & Outcomes Research, Division of Pediatric Surgery, Johns Hopkins University School of Medicine
| | - Fizan Abdullah
- Center for Pediatric Surgical Clinical Trials & Outcomes Research, Division of Pediatric Surgery, Johns Hopkins University School of Medicine
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Shah PS, Lee SK, Lui K, Sjörs G, Mori R, Reichman B, Håkansson S, Feliciano LS, Modi N, Adams M, Darlow B, Fujimura M, Kusuda S, Haslam R, Mirea L. The International Network for Evaluating Outcomes of very low birth weight, very preterm neonates (iNeo): a protocol for collaborative comparisons of international health services for quality improvement in neonatal care. BMC Pediatr 2014; 14:110. [PMID: 24758585 PMCID: PMC4021416 DOI: 10.1186/1471-2431-14-110] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 03/05/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The International Network for Evaluating Outcomes in Neonates (iNeo) is a collaboration of population-based national neonatal networks including Australia and New Zealand, Canada, Israel, Japan, Spain, Sweden, Switzerland, and the UK. The aim of iNeo is to provide a platform for comparative evaluation of outcomes of very preterm and very low birth weight neonates at the national, site, and individual level to generate evidence for improvement of outcomes in these infants. METHODS/DESIGN Individual-level data from each iNeo network will be used for comparative analysis of neonatal outcomes between networks. Variations in outcomes will be identified and disseminated to generate hypotheses regarding factors impacting outcome variation. Detailed information on physical and environmental factors, human and resource factors, and processes of care will be collected from network sites, and tested for association with neonatal outcomes. Subsequently, changes in identified practices that may influence the variations in outcomes will be implemented and evaluated using quality improvement methods. DISCUSSION The evidence obtained using the iNeo platform will enable clinical teams from member networks to identify, implement, and evaluate practice and service provision changes aimed at improving the care and outcomes of very low birth weight and very preterm infants within their respective countries. The knowledge generated will be available worldwide with a likely global impact.
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Affiliation(s)
- Prakesh S Shah
- Canadian Neonatal Network, Maternal-Infant Care Research Centre, Mount Sinai Hospital, 700 University Avenue, Toronto, Ontario M5G 1X6, Canada
| | - Shoo K Lee
- Canadian Neonatal Network, Maternal-Infant Care Research Centre, Mount Sinai Hospital, 700 University Avenue, Toronto, Ontario M5G 1X6, Canada
| | - Kei Lui
- Australia and New Zealand Neonatal Network, Royal Hospital for Women, Level 2, McNevin Dickson Building, Sydney Children’s Hospital, Randwick, NSW 2031, Australia
| | - Gunnar Sjörs
- Swedish Neonatal Quality Register, Department of Women’s and Children’s Health, Uppsala University, 751 85 Uppsala, Sweden
| | - Rintaro Mori
- Neonatal Research Network Japan, Department of Health Policy, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo 157-8535, Japan
| | - Brian Reichman
- Israeli Neonatal Network, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Centre, Tel Hashomer 52621, Israel
| | - Stellan Håkansson
- Swedish Neonatal Quality Register, Department of Pediatrics, Umea University Hospital, SE-901 85 Umeå, Sweden
| | - Laura San Feliciano
- Spanish Neonatal Network, Unidad Neonatal Barakaldo, Plaza de cruces s/n, 5ª Planta, Unidad Neonatal, Barakaldo 48903, (Bizkaia), Spain
| | - Neena Modi
- UK Neonatal Collaborative, Imperial College London, Chelsea and Westminster Hospital Campus, London SW10 9NH, UK
| | - Mark Adams
- Swiss Neonatal Network, Division of Neonatology, University Hospital Zurich, Frauenklinikstrasse 10, CH-8091 Zürich, Switzerland
| | - Brian Darlow
- Australia and New Zealand Neonatal Network, University of Otago, Christchurch, 2 Riccarton Avenue, PO Box 4345, Christchurch 8140, New Zealand
| | - Masanori Fujimura
- Neonatal Research Network Japan, Osaka Medical Center and Research Institute for Maternal and Child Health, 840 Murodo-cho, Izumi, Osaka 594-1101, Japan
| | - Satoshi Kusuda
- Neonatal Research Network Japan, Maternal and Perinatal Center, Tokyo Women’s Medical University, 8-1 Kawadacho, Shinjuku-ku, Tokyo 162-8666, Japan
| | - Ross Haslam
- Australia and New Zealand Neonatal Network, Women’s and Children’s Hospital, Adelaide, Level 2, McNevin Dickson Building, Sydney Children’s Hospital, Randwick, NSW 2031, Australia
| | - Lucia Mirea
- Canadian Neonatal Network, Maternal-Infant Care Research Centre, Mount Sinai Hospital, 700 University Avenue, Toronto, Ontario M5G 1X6, Canada
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