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 Guller

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1527-1533
Number of pages7
JournalWorld Journal of Surgery
Volume36
Issue number7
DOIs
StatePublished - Jul 2012
Externally publishedYes

Fingerprint

Appendectomy
Odds Ratio
Length of Stay
Appendicitis
Risk Adjustment
Mortality
Intraoperative Complications
Hospital Mortality
Reoperation
Renal Insufficiency
Inpatients
Linear Models
Myocardial Infarction
Regression Analysis
Morbidity
Lung

ASJC Scopus subject areas

  • Surgery

Cite this

Laparoscopic appendectomy outcomes on the weekend and during the week are no different : A national study of 151,774 patients. / Worni, Mathias; Østbye, Truls; Gandhi, Mihir; Rajgor, Dimple; Shah, Jatin; Shah, Anand; Pietrobon, Ricardo; Jacobs, Danny O.; Guller, Ulrich.

In: World Journal of Surgery, Vol. 36, No. 7, 07.2012, p. 1527-1533.

Research output: Contribution to journalArticle

Worni, M, Østbye, T, Gandhi, M, Rajgor, D, Shah, J, Shah, A, Pietrobon, R, Jacobs, DO & Guller, U 2012, 'Laparoscopic appendectomy outcomes on the weekend and during the week are no different: A national study of 151,774 patients', World Journal of Surgery, vol. 36, no. 7, pp. 1527-1533. https://doi.org/10.1007/s00268-012-1550-z
Worni, Mathias ; Østbye, Truls ; Gandhi, Mihir ; Rajgor, Dimple ; Shah, Jatin ; Shah, Anand ; Pietrobon, Ricardo ; Jacobs, Danny O. ; Guller, Ulrich. / Laparoscopic appendectomy outcomes on the weekend and during the week are no different : A national study of 151,774 patients. In: World Journal of Surgery. 2012 ; Vol. 36, No. 7. pp. 1527-1533.
@article{c5a9b145af454a92a9ddf6f82e698017,
title = "Laparoscopic appendectomy outcomes on the weekend and during the week are no different: A national study of 151,774 patients",
abstract = "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.",
author = "Mathias Worni and Truls {\O}stbye and Mihir Gandhi and Dimple Rajgor and Jatin Shah and Anand Shah and Ricardo Pietrobon and Jacobs, {Danny O.} and Ulrich Guller",
year = "2012",
month = "7",
doi = "10.1007/s00268-012-1550-z",
language = "English (US)",
volume = "36",
pages = "1527--1533",
journal = "Presentations from the 9th Annual Electric Utilities Environmental Conference",
issn = "0364-2313",
publisher = "Springer New York",
number = "7",

}

TY - JOUR

T1 - Laparoscopic appendectomy outcomes on the weekend and during the week are no different

T2 - A national study of 151,774 patients

AU - Worni, Mathias

AU - Østbye, Truls

AU - Gandhi, Mihir

AU - Rajgor, Dimple

AU - Shah, Jatin

AU - Shah, Anand

AU - Pietrobon, Ricardo

AU - Jacobs, Danny O.

AU - Guller, Ulrich

PY - 2012/7

Y1 - 2012/7

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=84864287188&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84864287188&partnerID=8YFLogxK

U2 - 10.1007/s00268-012-1550-z

DO - 10.1007/s00268-012-1550-z

M3 - Article

VL - 36

SP - 1527

EP - 1533

JO - Presentations from the 9th Annual Electric Utilities Environmental Conference

JF - Presentations from the 9th Annual Electric Utilities Environmental Conference

SN - 0364-2313

IS - 7

ER -