title: Weekend versus weekday transplant surgery and outcomes after kidney transplantation in the USA: a retrospective national database analysis.
abstract: OBJECTIVE
  To determine whether kidney transplants performed during a weekend had worse outcomes than those performed during weekdays.
  
  
  METHODS
  Retrospective national database study.
  
  
  METHODS
  United Network for Organ Sharing database of the USA.
  
  
  METHODS
  136,715 adult recipients of deceased donor single organ kidney transplants in the USA between 4/1994 and 9/2010.
  
  
  METHODS
  The primary outcomes were patient survival and death-censored and overall allograft survival. Secondary outcomes included initial length of hospital stay after transplantation, delayed allograft function, acute rejection within the first year of transplant, and patient and allograft survival at 1 month and at 1 year after transplantation. Cox proportional hazards models were used to evaluate the impact of weekend kidney transplant surgery on primary and secondary outcomes, adjusting for multiple covariates.
  
  
  RESULTS
  Among the 136,715 kidney recipients, 72.5% underwent transplantation during a regular weekday (Monday-Friday) and 27.5% during a weekend (Saturday-Sunday). No significant association was noted between weekend transplant status and patient survival, death-censored allograft survival or overall allograft survival in the adjusted analyses (HR 1.01 (95% CI 0.92 to 1.04), 1.012 (95% CI 0.99 to 1.034), 1.012 (95% CI 0.984 to 1.04), respectively). In addition, no significant association was noted between weekend transplant status and the secondary outcomes of patient and graft survival at 1 month and 1 year, delayed allograft function or acute rejection within the first year. Results remained consistent across all definitions of weekend status.
  
  
  CONCLUSIONS
  The outcomes for deceased donor kidney transplantation in the USA are not affected by the day of surgery. The operationalisation of deceased donor kidney transplantation may provide a model for other surgeries or emergency procedures that occur over the weekend, and may help reduce length of hospital stay and improve outcomes.
authors.affiliation: Department of Nephrology and Transplant Center, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Seema
authors.identifier: http://orcid.org/0000-0001-8192-1079
authors.initials: S
authors.lastname: Baid-Agrawal
authors.affiliation: Institute for Clinical Epidemiology and Applied Biometry, University Clinic of Tuebingen, Tuebingen, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Martus
authors.affiliation: Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania, USA.
authors.forename: Harold
authors.initials: H
authors.lastname: Feldman
authors.affiliation: Department of Public Health Sciences and Medicine, Division of Nephrology and Hypertension, Loyola Medical Center, Maywood, Illinois, USA.
authors.forename: Holly
authors.initials: H
authors.lastname: Kramer
mesh_terms: D000328:Adult; D016208:Databases, Factual; D005260:Female; D006085:Graft Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation / Q000401:mortality* / Q000639:trends*; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
keywords: graft survival; kidney transplantation; patient survival; weekend effect