title: Complication rates on weekends and weekdays in US hospitals.
abstract: OBJECTIVE
  Recent studies and anecdotal evidence suggest that patient safety may be compromised on weekends. Our objective was to determine whether rates of complications in hospitals are higher on weekends than on weekdays.
  
  
  METHODS
  We examined records from 4,967,114 admissions to acute care hospitals in 3 states and analyzed complication rates using the Patient Safety Indicators. We selected 8 indicators that could be assigned to a single day: complications of anesthesia, retained foreign bodies, postoperative hemorrhage, accidental cuts and lacerations during procedures, birth trauma, obstetric trauma during vaginal deliveries with and without instrumentation, and obstetric trauma during cesarean delivery. Odds ratios (ORs) comparing weekends versus weekdays were adjusted for demographics, type of admission, and admission route. In a subgroup analysis of surgical complications, we restricted the population to patients who underwent cardiac or vascular procedures.
  
  
  RESULTS
  Four of the 8 complications occurred more frequently on weekends: postoperative hemorrhage (OR 1.07, 95% confidence interval [CI], 1.01-1.14), newborn trauma (OR 1.06, 95% CI, 1.03-1.10), vaginal deliveries without instrumentation (OR 1.03, 95% CI, 1.02-1.04), and obstetric trauma during cesarean sections (OR 1.36, 95% CI, 1.29-1.44). Complications related to anesthesia occurred less frequently on weekends (OR 0.86). Among patients undergoing vascular procedures, surgical complications occurred more frequently on weekends (OR 1.46, 95% CI, 1.16-1.85).
  
  
  CONCLUSIONS
  Rates of complications are marginally higher on weekends than on weekdays for some surgical and newborn complications, but more significantly for obstetric trauma and for surgical complications involving patients undergoing vascular procedures. Hospitals should work toward increasing the robustness of safeguards on weekends.
authors.affiliation: Center for Health Policy, Stanford Medical School, Stanford, Calif 94305, USA. ebd@stanford.edu
authors.forename: Eran
authors.initials: E
authors.lastname: Bendavid
authors.forename: Yevgenia
authors.initials: Y
authors.lastname: Kaganova
authors.forename: Jack
authors.initials: J
authors.lastname: Needleman
authors.forename: Leonard
authors.initials: L
authors.lastname: Gruenberg
authors.forename: Joel S
authors.initials: JS
authors.lastname: Weissman
mesh_terms: D000328:Adult; D000758:Anesthesia / Q000009:adverse effects; D036861:Delivery, Obstetric / Q000592:standards; D005260:Female; D005547:Foreign Bodies / Q000453:epidemiology; D006693:Holidays; D006761:Hospitals / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D007049:Iatrogenic Disease / Q000453:epidemiology*; D016015:Logistic Models; D008297:Male; D019300:Medical Errors / Q000706:statistics & numerical data*; D017063:Outcome Assessment, Health Care; D010343:Patient Admission / Q000706:statistics & numerical data; D010561:Personnel Staffing and Scheduling; D011183:Postoperative Complications / Q000453:epidemiology*; D011247:Pregnancy; D011787:Quality of Health Care; D012189:Retrospective Studies; D012449:Safety; D013995:Time; D014481:United States / Q000453:epidemiology