Advertisement

World Journal of Surgery

, Volume 36, Issue 7, pp 1527–1533 | Cite as

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

  • Mathias Worni
  • Truls Østbye
  • Mihir Gandhi
  • Dimple Rajgor
  • Jatin Shah
  • Anand Shah
  • Ricardo Pietrobon
  • Danny O. Jacobs
  • Ulrich GullerEmail author
Article

Abstract

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 39.6 years, 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: 2.00 days, weekends: 2.01 days, 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.

Keywords

Appendicitis Acute Appendicitis Pulmonary Complication Laparoscopic Appendectomy Nationwide Inpatient Sample 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgment

The authors thank the Research on Research Group (http://researchonresearch.duhs.duke.edu/, last accessed 10/2011) for the research process platforms used in the preparation of our manuscript []. This work was supported by grant PBBEP3-131567 from the Swiss National Science Foundation (MW). The authors have no conflicts of interest, including specific financial interests and relationships and affiliations relevant to the subject matter or materials discussed in the manuscript) [32, 33].

References

  1. 1.
    Hall MJ, DeFrances CJ, Williams SN et al (2010) National hospital discharge survey: 2007 summary. Nat Health Stat Rep 1–20:24Google Scholar
  2. 2.
    DeCoster C, Roos NP, Carriere KC, Peterson S (1997) Inappropriate hospital use by patients receiving care for medical conditions: targeting utilization review. CMAJ 157:889–896PubMedGoogle Scholar
  3. 3.
    Petersen LA, Brennan TA, O’Neil AC et al (1994) Does housestaff discontinuity of care increase the risk for preventable adverse events? Ann Intern Med 121:866–872PubMedGoogle Scholar
  4. 4.
    Hamilton P, Eschiti VS, Hernandez K, Neill D (2007) Differences between weekend and weekday nurse work environments and patient outcomes: a focus group approach to model testing. J Perinat Neonatal Nurs 21:331–341PubMedGoogle Scholar
  5. 5.
    Angus DC, Shorr AF, White A et al (2006) Critical care delivery in the United States: distribution of services and compliance with Leapfrog recommendations. Crit Care Med 34:1016–1024PubMedCrossRefGoogle Scholar
  6. 6.
    Bell CM, Redelmeier DA (2001) Mortality among patients admitted to hospitals on weekends as compared with weekdays. N Engl J Med 345:663–668PubMedCrossRefGoogle Scholar
  7. 7.
    Kostis WJ, Demissie K, Marcella SW et al (2007) Weekend versus weekday admission and mortality from myocardial infarction. N Engl J Med 356:1099–1109PubMedCrossRefGoogle Scholar
  8. 8.
    James MT, Wald R, Bell CM et al (2010) Weekend hospital admission, acute kidney injury, and mortality. J Am Soc Nephrol 21:845–851PubMedCrossRefGoogle Scholar
  9. 9.
    Barba R, Losa JE, Velasco M et al (2006) Mortality among adult patients admitted to the hospital on weekends. Eur J Intern Med 17:322–324PubMedCrossRefGoogle Scholar
  10. 10.
    Dorn SD, Shah ND, Berg BP, Naessens JM (2010) Effect of weekend hospital admission on gastrointestinal hemorrhage outcomes. Dig Dis Sci 55:1658–1666PubMedCrossRefGoogle Scholar
  11. 11.
    Cram P, Hillis SL, Barnett M, Rosenthal GE (2004) Effects of weekend admission and hospital teaching status on in-hospital mortality. Am J Med 117:151–157PubMedCrossRefGoogle Scholar
  12. 12.
    Crowley RW, Yeoh HK, Stukenborg GJ et al (2009) Influence of weekend hospital admission on short-term mortality after intracerebral hemorrhage. Stroke 40:2387–2392PubMedCrossRefGoogle Scholar
  13. 13.
    Magid DJ, Wang Y, Herrin J et al (2005) Relationship between time of day, day of week, timeliness of reperfusion, and in-hospital mortality for patients with acute ST-segment elevation myocardial infarction. JAMA 294:803–812PubMedCrossRefGoogle Scholar
  14. 14.
    Myers RP, Kaplan GG, Shaheen AM (2009) The effect of weekend versus weekday admission on outcomes of esophageal variceal hemorrhage. Can J Gastroenterol 23:495–501PubMedGoogle Scholar
  15. 15.
    Shaheen AA, Kaplan GG, Myers RP (2009) Weekend versus weekday admission and mortality from gastrointestinal hemorrhage caused by peptic ulcer disease. Clin Gastroenterol Hepatol 7:303–310PubMedCrossRefGoogle Scholar
  16. 16.
    Ditillo MF, Dziura JD, Rabinovici R (2006) Is it safe to delay appendectomy in adults with acute appendicitis? Ann Surg 244:656–660PubMedCrossRefGoogle Scholar
  17. 17.
    Sheu BF, Chiu TF, Chen JC et al (2007) Risk factors associated with perforated appendicitis in elderly patients presenting with signs and symptoms of acute appendicitis. ANZ J Surg 77:662–666PubMedCrossRefGoogle Scholar
  18. 18.
    Kearney D, Cahill RA, O’Brien E et al (2008) Influence of delays on perforation risk in adults with acute appendicitis. Dis Colon Rectum 51:1823–1827PubMedCrossRefGoogle Scholar
  19. 19.
    Stahlfeld K, Hower J, Homitsky S, Madden J (2007) Is acute appendicitis a surgical emergency? Am Surg 73:626–629 (discussion 629–630)PubMedGoogle Scholar
  20. 20.
    Abou-Nukta F, Bakhos C, Arroyo K et al (2006) Effects of delaying appendectomy for acute appendicitis for 12 to 24 hours. Arch Surg 141:504–506 (discussion 506–507)PubMedCrossRefGoogle Scholar
  21. 21.
    Guller U, Hervey S, Purves H et al (2004) Laparoscopic versus open appendectomy: outcomes comparison based on a large administrative database. Ann Surg 239:43–52PubMedCrossRefGoogle Scholar
  22. 22.
    http://www.hcup-us.ahrq.gov/nisoverview.jsp. Overview of the Nationwide Inpatient Sample (NIS). Accessed 4 March 2012
  23. 23.
    Deyo RA, Cherkin DC, Ciol MA (1992) Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol 45:613–619PubMedCrossRefGoogle Scholar
  24. 24.
    Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383PubMedCrossRefGoogle Scholar
  25. 25.
    Crowley RW, Yeoh HK, Stukenborg GJ et al (2009) Influence of weekend versus weekday hospital admission on mortality following subarachnoid hemorrhage. J Neurosurg 111:60–66PubMedCrossRefGoogle Scholar
  26. 26.
    Matsui K, Kojima S, Sakamoto T et al (2007) Weekend onset of acute myocardial infarction does not have a negative impact on outcome in Japan. Circ J 71:1841–1844PubMedCrossRefGoogle Scholar
  27. 27.
    Tarnow-Mordi WO, Hau C, Warden A, Shearer AJ (2000) Hospital mortality in relation to staff workload: a 4-year study in an adult intensive-care unit. Lancet 356:185–189PubMedCrossRefGoogle Scholar
  28. 28.
    Cho SH, Hwang JH, Kim J (2008) Nurse staffing and patient mortality in intensive care units. Nurs Res 57:322–330PubMedCrossRefGoogle Scholar
  29. 29.
    Needleman J, Buerhaus P, Mattke S et al (2002) Nurse-staffing levels and the quality of care in hospitals. N Engl J Med 346:1715–1722PubMedCrossRefGoogle Scholar
  30. 30.
    Clark K, Normile LB (2007) Influence of time-to-interventions for emergency department critical care patients on hospital mortality. J Emerg Nurs 33:6–13 (quiz 90)PubMedCrossRefGoogle Scholar
  31. 31.
    Hansson LE, Laurell H, Gunnarsson U (2008) Impact of time in the development of acute appendicitis. Dig Surg 25:394–399PubMedCrossRefGoogle Scholar
  32. 32.
    Shah J, Shah A, Pietrobon R (2009) Scientific writing of novice researchers: what difficulties and encouragements do they encounter? Acad Med 84:511–516PubMedCrossRefGoogle Scholar
  33. 33.
    Pietrobon R, Guller U, Martins H et al (2004) A suite of web applications to streamline the interdisciplinary collaboration in secondary data analyses. BMC Med Res Methodol 4:29PubMedCrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2012

Authors and Affiliations

  • Mathias Worni
    • 1
    • 2
  • Truls Østbye
    • 3
    • 4
  • Mihir Gandhi
    • 1
    • 4
    • 5
  • Dimple Rajgor
    • 1
  • Jatin Shah
    • 1
  • Anand Shah
    • 1
  • Ricardo Pietrobon
    • 1
  • Danny O. Jacobs
    • 6
  • Ulrich Guller
    • 2
    • 7
    Email author
  1. 1.Research on Research Group, Department of SurgeryDuke University Medical CenterDurhamUSA
  2. 2.Department of Visceral Surgery and MedicineInselspital, Berne University HospitalBerneSwitzerland
  3. 3.Department of Community and Family MedicineDuke University Medical CenterDurhamUSA
  4. 4.Duke-NUS Graduate Medical SchoolSingaporeSingapore
  5. 5.Singapore Clinical Research InstituteSingaporeSingapore
  6. 6.Department of SurgeryDuke University Medical CenterDurhamUSA
  7. 7.Department of Medical Oncology & HematologyKantonal Hospital St. GallenSt. GallenSwitzerland

Personalised recommendations