How hospitals can improve outcomes of weekend surgeries

April 25, 2015

Studies have shown that patients who undergo surgeries on weekends tend to experience longer hospital stays and higher mortality rates and readmissions.

For the first time, a new study has identified five resources that can help hospitals overcome this "weekend effect": Increased nurse-to bed ratio; full adoption of electronic medical records; inpatient physical rehabilitation; a home-health program; and a pain management program.

"Specific hospital resources can overcome the weekend effect seen in urgent general surgery procedures," senior author Paul Kuo, MD, MS, MBA, first author Anai Kothari, MD, and colleagues reported. The study was released April 25, 2015, in a podium presentation at the American Surgical Association meeting in San Diego.

Several reasons have been proposed to explain the weekend effect, including reduced staffing and resources and fewer experienced doctors and nurses working on weekends.

Loyola researchers hypothesized that boosting hospital resources before, during and after could overcome the weekend effect. They tested their hypothesis in patients undergoing three types of urgent surgeries that could not be delayed until weekdays: appendectomies, hernia repairs and gall bladder removals.

The researchers examined records of 126,666 patients at 117 Florida hospitals participating in a data base program sponsored by the U.S. Agency for Healthcare Research and Quality. Florida was picked because of its large, diverse population. To determine characteristics of individual hospitals, the patient data were linked to the American Hospital Association Annual Survey database.

Of the 21 hospital resources researchers examined, five were found to help overcome the weekend effect after controlling for patient characteristics:

  • Hospitals with increased nurse-to-bed ratios were 1.44 times more likely to overcome the weekend effect. Seventeen hospitals that overcame the weekend effect had a median nurse-to-bed ratio of 1.3, compared with a nurse-to-bed ratio of 1.1 among 41 hospitals with a persistent weekend effect.
  • Hospitals with home health programs were 2.37 times more likely to overcome the weekend effect. In such programs, skilled caregivers check on patients after they are discharged, providing wound care, administering medications, etc.
  • Hospitals that fully adopted electronic medical records were 4.74 times more likely to overcome the weekend effect.
  • Hospitals with inpatient programs were 1.03 times more likely to overcome the weekend effect. Such programs identify patients who require additional physical conditioning prior to discharge or need extra resources at home.
  • Hospitals with pain management programs were 1.48 times more likely to overcome the weekend effect.

Researchers plan to conduct a follow-up study of hospitals in California, which also has a large, diverse population.

The study was conducted by Loyola's predictive analytics program, which mines large data sets to predict health outcomes. In addition to the weekend effect study, researchers are studying, for example, how many rectal cancer operations a hospital needs to perform for the best results, and whether having a trauma department confers a beneficial "halo effect" on patient outcomes across the board.

Large new databases, and more powerful computers are enabling researchers to conduct such studies. "We're now able to ask and answer a broad range of questions that could significantly help improve patient care and reduce costs," Dr. Kuo said. Dr. Kuo heads Loyola's analytics group, One to Map Analytics. (One-to-map is a common computer command in analytics research.)

Dr. Kuo is the John P. Igini professor and chair of the Department of Surgery of Loyola University Chicago Stritch School of Medicine.The study is titled, "Components Of Hospital Perioperative Infrastructure Can Overcome The Weekend Effect In Urgent General Surgery Procedures." In addition to Dr. Kuo and Dr. Kothari, other co-authors are Matthew Zapf; Robert Blackwell, MD; Victor Chang; Zhiyong Mi, PhD; and Gopal Gupta, MD.

The complete manuscript of this study and its presentation at the American Surgical Association's 135th Annual Meeting, April 2015, in San Diego, California, is anticipated to be published in the Annals of Surgery pending editorial review.

Explore further: No 'weekend effect' seen following appendix removal operations

Related Stories

No 'weekend effect' seen following appendix removal operations

October 7, 2013
Patients who undergo surgical removal of the appendix on a weekend do not experience more postoperative complications than those who undergo the same operation on weekdays, but they do pay slightly more in hospital charges, ...

Study of 55 million people adds further evidence that patients admitted to hospital at weekends have higher mortality

June 1, 2014
A systematic review and meta-analysis of hospital data worldwide, presented as this year's Euroanaesthesia meeting in Stockholm, adds further evidence that patients admitted to hospital at weekends have higher mortality than ...

Higher death rates for weekend hospital stays regardless of day of admission

May 14, 2014
People hospitalised with COPD or pneumonia are more likely to die during a weekend stay in hospital, according to a new study.

Nurse staffing and mortality in stroke centers

August 19, 2014
Hospital staffing levels have been associated with patient outcomes, but staffing on weekends has not been well studied, despite a recent UK mandate to make physician specialist care 7 days a week a policy and service improvement ...

Weekend emergency surgeries deadlier for children

July 2, 2014
Children who undergo simple emergency surgeries, such as hernia repairs or appendix removals, on weekends are more likely to suffer complications and even die than children getting the same kind of treatment during the week, ...

Weekend hospitalization linked to longer stay for pediatric leukemia patients

August 25, 2014
Weekend admission to the hospital for pediatric patients newly diagnosed with leukemia was associated with a longer length of stay, slightly longer wait to start chemotherapy and higher risk for respiratory failure but weekend ...

Recommended for you

Defining optimal opioid pain medication prescription length following surgery

September 27, 2017
A new study led by researchers at the Center for Surgery and Public Health at Brigham and Women's Hospital analyzed opioid prescription data from the Department of Defense Military Health System Data Repository, identifying ...

Is older blood OK to use in a transfusion?

September 27, 2017
(HealthDay)—Using older red blood cells to give transfusions to critically ill patients doesn't appear to affect their risk of dying, Australian researchers report.

One weight-loss surgery shows lasting results

September 21, 2017
(HealthDay)—Obesity surgery can have long-lasting effects on weight and the risk of developing type 2 diabetes and high blood pressure, a new study finds.

Hold the phone: An ambulance might lower your chances of surviving some injuries

September 20, 2017
Victims of gunshots and stabbings are significantly less likely to die if they're taken to the trauma center by a private vehicle than ground emergency medical services (EMS), according to results of a new analysis.

Surgeons have major influence on breast cancer treatment

September 13, 2017
A woman's choice of surgeon plays a significant role in whether she's likely to receive an increasingly popular aggressive breast cancer surgery.

Some thyroid cancer patients can safely delay surgery

September 4, 2017
Most people diagnosed with cancer want to start treatment as soon as possible, for fear that delaying care will allow their tumor to grow out of control.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.