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Components Of Hospital Perioperative Infrastructure Can Overcome The Weekend Effect In Urgent General Surgery Procedures
Anai N Kothari*1, Matthew AC Zapf*2, Robert Blackwell*3, Victor Chang*2, Zhiyong Mi*1, Gopal N Gupta*3, Paul C Kuo1
1Loyola University Chicago, Department of Surgery, Maywood, IL;2Stritch School of Medicine, Maywood, IL;3Loyola University Chicago, Department of Urology, Maywood, IL

OBJECTIVE(S) - The “weekend effect” (WE) is the observation that surgeon-independent patient outcomes are worse on the weekend compared to weekdays. We hypothesized that perioperative hospital resources could overcome the WE in patients undergoing emergent/urgent surgeries.
METHODS -Emergent/urgent surgeries were identified using the Healthcare Cost and Utilization Project State Inpatient Database (Florida) from 2007-2011 and were linked to the American Hospital Association Annual Survey database to determine hospital level characteristics. Extended median length of stay on the weekend compared to the weekday (after controlling for hospital, year, and procedure type) was selected as a surrogate for WE.
RESULTS - Included were 127,221 patients at 166 hospitals. A total of 17 hospitals overcame the WE during the study period. Logistic regression, controlling for patient characteristics, identified high resolution CT scanner (OR 1.33)*, home health program (OR 1.88)*, social work program (OR 1.37)*, full adoption of electronic medical records (OR 1.62)*, and increased nurse-to-bed ratio (OR 2.55)* as hospital resources that overcame the WE following implementation. The prevalence of these factors in hospitals exhibiting the WE for all 5 years of the study period were compared to those hospitals which overcame the WE. (*p<0.0001)
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.
Comparing Hospitals With and Without WE
Hospital FactorHospitals That Overcame WE (n=17)Hospitals With Persistent WE (n=40)p value
Nurse to Bed Ratio1.461.220.0001
Home Health Program (%)27.3%29.6%0.8609
Patient Controlled Analgesia (%)93.8%83.3%0.2896
Electronic Medical Records (%)55.6%13.1%0.0008
Social Work (%)98.7%82.3%0.0091
High Resolution CT Scanner (%)61.4%50.4%0.4461


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