Outcomes of common general surgery procedures for patients discharged over weekends at a tertiary care hospital in Saudi Arabia

Abstract

BACKGROUNDHospitals usually reduce staffing levels and services over weekends. This raises the question of whether patients discharged over a weekend may be inadequately prepared and possibly at higher risk of adverse events post-discharge.OBJECTIVESTo assess the outcomes of common general surgery procedures for patients discharged over weekends, and to identify the key predictors of early readmission.DESIGNRetrospective cohort study.SETTINGA tertiary care center.PATIENTS AND METHODSPatients discharged from general surgery services during the one-year period between January and December 2016 after cholecystectomy, appendectomy, or hernia repairs were included. Patient demographic information, comorbidities, and complications as well as admission and follow-up details were collected from electronic medical records.MAIN OUTCOME MEASURESOutcomes following weekend discharge, and the predictors of early readmission.SAMPLE SIZE743 patients.RESULTSThe operations performed: 361 patients (48.6%) underwent a cholecystectomy, 288 (38.8%) an appendectomy, and 94 (12.6%) hernia repairs. A significantly lower number of patients were discharged over the weekend (n=125) compared to those discharged on weekdays (n=618). Patients discharged during the weekend were younger, less likely to have chronic diseases, and had a significantly shorter average length of stay (LOS) (median 2 days, IQR: 1, 4 vs. median 3 days, IQR: 1, 5, P=.002). Overall, the 30-day readmission rate was 3.2% (n=24), and weekend discharge (OR=2.25, 95% CI 0.52–9.70) or any other variable did not predict readmission in 30 days. However, 14-day post-discharge follow-up visits were significantly lower in the weekend discharge subgroup (83.1% vs. 91.2%, P=.006).CONCLUSIONWeekend discharge was not associated with higher readmission rates. Physicians may consider discharging post-operative patients over a weekend without an increased risk to the patient. Day of discharge, length of stay and increased patient age are not predictors of early readmission.LIMITATIONSSingle-center study and retrospective.

Length of hospital stay after uncomplicated esophagectomy. Hospital variation shows room for nationwide improvement

“…Several studies investigated the effect of weekend discharge on readmission after other types of surgery than esophagectomy. None found higher readmission rates after weekend discharge [41][42][43][44][45]. All of these studies included patients both with and without complications.…”

Holiday ratio of hospitalization and 30‐day readmission rates among cancer patients after major surgery

“…The most commonly used was discharge on a weekend. 6 , 16 , 21 , 22 , 23 , 24 , 25 According to the literatures, patients discharged on the weekends or holidays may have low continuity of care because of personnel staffing levels, procedures delay, and loss of information on handoffs … et al We also created a new indicator, named holiday ratio, determined as: …”

“…We tried to find a new proxy which could represent continuity of care during hospitalization. The most commonly used was discharge on a weekend 6,16,21–25 . According to the literatures, patients discharged on the weekends or holidays may have low continuity of care because of personnel staffing levels, procedures delay, and loss of information on handoffs … et al We also created a new indicator, named holiday ratio, determined as:…”

Outcomes of Common General Surgery Patients Discharged Over Weekends at a Tertiary Care Hospital in Taif, Saudi Arabia

“…This effect, however, may not exist in all healthcare systems and may be partially attributable to the increased severity of patients who present to the hospital on weekends, indicating delayed care-seeking [4]. Prior research [5] has demonstrated that the discharge of fewer patients on weekends compared to weekdays leads to unnecessary increases in length of stay.…”