title: The effect of weekend and after-hours surgery on morbidity and mortality rates in pediatric neurosurgery patients.
abstract: OBJECTIVE
  Several studies have indicated that the 30-day morbidity and mortality risks are higher among pediatric and adult patients who are admitted on the weekends. This "weekend effect" has been observed among patients admitted with and for a variety of diagnoses and procedures, including myocardial infarction, pulmonary embolism, ruptured abdominal aortic aneurysm, stroke, peptic ulcer disease, and pediatric surgery. In this study, morbidity and mortality outcomes for emergency pediatric neurosurgical procedures carried out on the weekend or after hours are compared with emergency surgical procedures performed during regular weekday business hours.
  
  
  METHODS
  A retrospective analysis of operative data was conducted. Between December 1, 2011, and August 20, 2014, a total of 710 urgent or emergency neurosurgical procedures were performed at Texas Children's Hospital in children younger than than 18 years of age. These procedures were then stratified into 3 groups: weekday regular hours, weekday after hours, and weekend hours. By cross-referencing these events with a prospectively collected morbidity and mortality database, the impact of the day and time on complication incidence was examined. Outcome metrics were compared using logistic regression models.
  
  
  RESULTS
  The weekday regular hours and after-hours (weekday after hours and weekends) surgery groups consisted of 341 and 239 patients and 434 and 276 procedures, respectively. There were no significant differences in the types of cases performed (p = 0.629) or baseline preoperative health status as determined by American Society of Anesthesiologists classifications (p = 0.220) between the 2 cohorts. After multivariate adjustment and regression, children undergoing emergency neurosurgical procedures during weekday after hours or weekends were more likely to experience complications (p = 0.0227).
  
  
  CONCLUSIONS
  Weekday after-hours and weekend emergency pediatric neurosurgical procedures are associated with significantly increased 30-day morbidity and mortality risk compared with procedures performed during weekday regular hours.
authors.affiliation: Division of Pediatric Neurosurgery, Texas Children's Hospital, Department of Neurosurgery, Baylor College of Medicine, Houston, Texas.
authors.forename: Virendra
authors.initials: V
authors.lastname: Desai
authors.affiliation: Division of Pediatric Neurosurgery, Texas Children's Hospital, Department of Neurosurgery, Baylor College of Medicine, Houston, Texas.
authors.forename: David
authors.initials: D
authors.lastname: Gonda
authors.affiliation: Division of Pediatric Neurosurgery, Texas Children's Hospital, Department of Neurosurgery, Baylor College of Medicine, Houston, Texas.
authors.forename: Sheila L
authors.initials: SL
authors.lastname: Ryan
authors.affiliation: Division of Pediatric Neurosurgery, Texas Children's Hospital, Department of Neurosurgery, Baylor College of Medicine, Houston, Texas.
authors.forename: Valentina
authors.initials: V
authors.lastname: Briceño
authors.affiliation: Division of Pediatric Neurosurgery, Texas Children's Hospital, Department of Neurosurgery, Baylor College of Medicine, Houston, Texas.
authors.forename: Sandi K
authors.initials: SK
authors.lastname: Lam
authors.affiliation: Division of Pediatric Neurosurgery, Texas Children's Hospital, Department of Neurosurgery, Baylor College of Medicine, Houston, Texas.
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Luerssen
authors.affiliation: Division of Pediatric Neurosurgery, Texas Children's Hospital, Department of Neurosurgery, Baylor College of Medicine, Houston, Texas.
authors.forename: Sohail H
authors.initials: SH
authors.lastname: Syed
authors.affiliation: Division of Pediatric Neurosurgery, Texas Children's Hospital, Department of Neurosurgery, Baylor College of Medicine, Houston, Texas.
authors.forename: Andrew
authors.initials: A
authors.lastname: Jea
mesh_terms: D000293:Adolescent; D039602:After-Hours Care / Q000706:statistics & numerical data*; D002557:Cerebrospinal Fluid Shunts / Q000009:adverse effects / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D005260:Female; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007223:Infant; D016015:Logistic Models; D008297:Male; D009017:Morbidity; D019635:Neurosurgical Procedures / Q000009:adverse effects* / Q000401:mortality*; D016017:Odds Ratio; D012189:Retrospective Studies; D013781:Texas / Q000453:epidemiology
keywords: ASA = American Society of Anesthesiologists; patient safety; pediatric neurosurgery; surgical outcomes