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  • The Effect of Weekend and After-Hours Surgery on Morbidity and Mortality Rates in Pediatric Neurosurgery

    Final Number:

    Virendra Rajendrakumar Desai MD; Andrew Jea MD; David D. Gonda MD; Sandi Lam MD MBA; Thomas G. Luerssen BS, MD, FACS, FAAP

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2015 Annual Meeting

    Introduction: Several studies have indicated that 30-day morbidity and mortality risk is 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, respectively, including myocardial infarction, pulmonary embolism, ruptured abdominal aortic aneurysm, stroke, peptic ulcer disease, and pediatric surgery. We sought to compare morbidity and mortality outcomes for emergent pediatric neurosurgical procedures done on the weekend or after-hours with emergent surgical procedures performed during regular weekday “business hours.”

    Methods: We conducted a retrospective collection of data. A total of 710 urgent or emergent neurosurgical procedures between December 1, 2011 and August 20, 2014 at Texas Children’s Hospital in children less than 18 years of age were performed. These surgical occurrences were then stratified into 3 groups: weekday regular-hours; weekday after-hours; and weekend. By cross-referencing these events with our prospectively collected morbidity and mortality database, we examined the impact of the day and time on complication incidence. Outcome metrics were compared using logistic regression models.

    Results: The weekday regular-hours and the after-hours (weekday after-hours or weekends) surgery groups comprised 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 the baseline pre-operative health status as determined by ASA classifications (p=0.220) between the two cohorts. After multivariate adjustment and Desai 4 regression, children undergoing emergency neurosurgical procedures during weekday after-hours and weekends were more likely to experience complications (p=0.027).

    Conclusions: Weekday after-hours and weekend emergent pediatric neurosurgical procedures are associated with significantly increased 30-day morbidity and mortality risk compared to procedures performed during weekday regular hours.

    Patient Care: Given that in our study, a higher incidence of morbidity was found in cases occurring during after-hours or weekend times, it is evident that there is a lack of optimal care during these times. The next step would be to identify what factors cause this sub-optimal care and discover a solution for them. We propose that the sub-optimal care stems from less experienced, more generalized surgical staff as well as decreased number of care-givers in the hospital during after-hours and propose one possible solution could be protocol-driven care.

    Learning Objectives: 1. To understand the effect of operating during after-hours or during weekends on patients' outcomes. 2. To identify complication rates between cases performed during regular hours versus after hours 3. To propose reasons for sub-optimal care during after-hours and methods for improving care during these times

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