title: The "weekend effect" in pediatric surgery - increased mortality for children undergoing urgent surgery during the weekend.
abstract: BACKGROUND
  For a number of pediatric and adult conditions, morbidity and mortality are increased when patients present to the hospital on a weekend compared to weekdays. The objective of this study was to compare pediatric surgical outcomes following weekend versus weekday procedures.
  
  
  METHODS
  Using the Nationwide Inpatient Sample and the Kids' Inpatient Database, we identified 439,457 pediatric (<18 years old) admissions from 1988 to 2010 that required a selected index surgical procedure (abscess drainage, appendectomy, inguinal hernia repair, open fracture reduction with internal fixation, or placement/revision of ventricular shunt) on the same day of admission. Outcome metrics were compared using logistic regression models that adjusted for patient and hospital characteristics as well as procedure performed.
  
  
  RESULTS
  Patient characteristics of those admitted on the weekend (n=112,064) and weekday (n=327,393) were similar, though patients admitted on the weekend were more likely to be coded as emergent (61% versus 53%). After multivariate adjustment and regression, patients undergoing a weekend procedure were more likely to die (OR 1.63, 95% CI 1.21-2.20), receive a blood transfusion despite similar rates of intraoperative hemorrhage (OR 1.15, 95% CI 1.01-1.26), and suffer from procedural complications (OR 1.40, 95% CI 1.14-1.74).
  
  
  CONCLUSIONS
  Pediatric patients undergoing common urgent surgical procedures during a weekend admission have a higher adjusted risk of death, blood transfusion, and procedural complications. While the exact etiology of these findings is not clear, the timing of surgical procedures should be considered in the context of systems-based deficiencies that may be detrimental to pediatric surgical care.
authors: Center for Pediatric Surgical Clinical Trials & Outcomes Research, Division of Pediatric Surgery, Johns Hopkins University School of Medicine. Electronic address: sgoldstein@jhmi.edu.
authors: Seth D
authors: SD
authors: Goldstein
authors: Center for Pediatric Surgical Clinical Trials & Outcomes Research, Division of Pediatric Surgery, Johns Hopkins University School of Medicine.
authors: Dominic J
authors: DJ
authors: Papandria
authors: Center for Pediatric Surgical Clinical Trials & Outcomes Research, Division of Pediatric Surgery, Johns Hopkins University School of Medicine.
authors: Jonathan
authors: J
authors: Aboagye
authors: Center for Pediatric Surgical Clinical Trials & Outcomes Research, Division of Pediatric Surgery, Johns Hopkins University School of Medicine.
authors: Jose H
authors: JH
authors: Salazar
authors: Center for Pediatric Surgical Clinical Trials & Outcomes Research, Division of Pediatric Surgery, Johns Hopkins University School of Medicine.
authors: Kyle
authors: K
authors: Van Arendonk
authors: Center for Pediatric Surgical Clinical Trials & Outcomes Research, Division of Pediatric Surgery, Johns Hopkins University School of Medicine.
authors: Khaled
authors: K
authors: Al-Omar
authors: Center for Pediatric Surgical Clinical Trials & Outcomes Research, Division of Pediatric Surgery, Johns Hopkins University School of Medicine.
authors: Gezzer
authors: G
authors: Ortega
authors: Center for Pediatric Surgical Clinical Trials & Outcomes Research, Division of Pediatric Surgery, Johns Hopkins University School of Medicine.
authors: Maria Grazia
authors: MG
authors: Sacco Casamassima
authors: Center for Pediatric Surgical Clinical Trials & Outcomes Research, Division of Pediatric Surgery, Johns Hopkins University School of Medicine.
authors: Fizan
authors: F
authors: Abdullah
mesh_terms: D000293:Adolescent; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D001803:Blood Transfusion / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D004638:Emergency Treatment / Q000009:adverse effects / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D017063:Outcome Assessment, Health Care; D010372:Pediatrics; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative / Q000009:adverse effects* / Q000401:mortality*; D013997:Time Factors
keywords: Kids' Inpatient Database; National Inpatient Sample; Patient safety; Pediatric surgery; Surgical outcomes; Weekend effect