title: Reevaluating the weekend effect on patients with hydrocephalus undergoing operative shunt intervention.
abstract: OBJECT Recently published data have suggested an increase in adverse outcomes in pediatric patients after insertion or revision of a ventricular CSF diversion shunt after a same-day weekend procedure. The authors undertook an evaluation of the impact of weekend admission and time to shunting on surgery-related quality outcomes in pediatric patients who underwent ventricular shunt insertion or revision. METHODS Pediatric patients with hydrocephalus who underwent ventriculoperitoneal, ventriculoatrial, or ventriculopleural shunt placement were selected from the 2000-2010 Nationwide Inpatient Sample and Kids' Inpatient Database. Multivariate regression analyses (adjusted for patient, hospital, case severity, and time to shunting) were used to determine the differences in inpatient mortality and routine discharge rates among patients admitted on a weekday versus those among patients admitted on a weekend. RESULTS There were 99,472 pediatric patients with shunted hydrocephalus, 16% of whom were admitted on a weekend. After adjustment for disease severity, time to procedure, and admission acuity, weekend admission was not associated with an increase in the inpatient mortality rate (p = 0.46) or a change in the percentage of routine discharges (p = 0.98) after ventricular shunt procedures. In addition, associations were unchanged after an evaluation of patients who underwent shunt revision surgery. High-volume centers were incidentally noted in multivariate analysis to have increased rates of routine discharge (OR 1.04 [95% CI 1.01-1.07]; p = 0.02). CONCLUSIONS Contrary to those of previous studies, the authors' data suggest that weekend admission is not associated with poorer outcomes for ventricular shunt insertion or revision. Increased rates of routine discharge were noted at high-volume centers.
authors.affiliation: Departments of 1 Neurosurgery.|Keck School of Medicine of USC, University of Southern California, Los Angeles; and.
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Attenello
authors.affiliation: Departments of 1 Neurosurgery.|Keck School of Medicine of USC, University of Southern California, Los Angeles; and.
authors.forename: Eisha
authors.initials: E
authors.lastname: Christian
authors.affiliation: Keck School of Medicine of USC, University of Southern California, Los Angeles; and.
authors.forename: Timothy
authors.initials: T
authors.lastname: Wen
authors.affiliation: Departments of 1 Neurosurgery.|Preventive Medicine, and.|Radiology.|Keck School of Medicine of USC, University of Southern California, Los Angeles; and.
authors.forename: Steven
authors.initials: S
authors.lastname: Cen
authors.affiliation: Departments of 1 Neurosurgery.|Keck School of Medicine of USC, University of Southern California, Los Angeles; and.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Zada
authors.affiliation: Departments of 1 Neurosurgery.|Division of Neurosurgery, Children's Hospital Los Angeles, California.
authors.forename: Erin N
authors.initials: EN
authors.lastname: Kiehna
authors.affiliation: Departments of 1 Neurosurgery.|Division of Neurosurgery, Children's Hospital Los Angeles, California.
authors.forename: Mark D
authors.initials: MD
authors.lastname: Krieger
authors.affiliation: Departments of 1 Neurosurgery.|Division of Neurosurgery, Children's Hospital Los Angeles, California.
authors.forename: J Gordon
authors.initials: JG
authors.lastname: McComb
authors.affiliation: Departments of 1 Neurosurgery.|Keck School of Medicine of USC, University of Southern California, Los Angeles; and.
authors.forename: William J
authors.initials: WJ
authors.lastname: Mack
keywords: CCC = complex chronic condition; HCUP = Healthcare Cost and Utilization Project; KID = Kids’ Inpatient Database; NIS = Nationwide Inpatient Sample; Nationwide Inpatient Sample; RR = rate ratio; cerebrospinal fluid; hydrocephalus; pediatric neurosurgery; time to surgery; ventriculoperitoneal shunt; weekend admission