Emergency diverticulitis surgery victim of the ‘weekend effect’

Patients who have emergency surgery at weekends for acute diverticulitis have worse outcomes than those admitted on weekdays, the results of a US study show.

Researchers found that patients undergoing left-sided colon resection at the weekend were more likely to undergo the Hartmann procedure than primary anastomosis - a technique that is associated with improved long-term outcomes.

Weekend patients also had higher rates of postoperative complications, reoperation, and nonroutine hospital discharge, and had longer stays in hospital.

The study included data from 31,892 patients in the US National Inpatient Sample, 22.2% of whom underwent surgery at the weekend.

The authors, reporting in the Archives of Surgery, found that weekend surgery increased the probability for undergoing a Hartmann procedure by 57%. In all, 53.9% of weekday patients had a Hartmann procedure compared with 64.8% of weekend patients.

They also report that while there were no differences in mortality rate or intraoperative complications, several outcomes were worse in those who had surgery at the weekend, compared with weekdays. For example, the probability for reoperation increased by 50% (2.1 vs 1.5%). The probability for mechanical wound complications increased by 41% (3.7 vs 2.9%) and for cardiovascular complications by 21% (3.8 vs 3.3%).

The authors say that their finding that weekend surgery led to a 0.5-day increase in median length of hospital stay and a US$ 3734 (€ 3033) increase in median total hospital charges highlights the need for improvements in quality of weekend care.

The study adds acute diverticulitis to a growing list of conditions that suffer from the so-called "weekend effect."

Previous authors have proposed time delays from admission to treatment as a major cause. However, the authors of this study found no differences in timing of surgery at the weekend compared with weekdays.

Another major proposed cause of the weekend effect is reduced staffing. The authors suggest that their findings may be attributed to lower availability of trained colorectal staff surgeons at the weekends. A previous study of emergency colorectal resections found that general surgeons had a significantly higher postoperative complication rate than specialist surgeons.

However, Mathias Worni (Duke University Medical Center, Durham, North Carolina, USA) and colleagues say their study could not establish the reasons for their observations: "Further investigations are warranted to examine possible underlying mechanisms involved in the weekend effect and to apply goal-directed strategies to improve patient outcomes."

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