The weekend effect on the provision of Emergency Surgery before and during the COVID-19 pandemic: case–control analysis of a retrospective multicentre database

Abstract

Introduction The concept of “weekend effect”, that is, substandard healthcare during weekends, has never been fully demonstrated, and the different outcomes of emergency surgical patients admitted during weekends may be due to different conditions at admission and/or different therapeutic approaches. Aim of this international audit was to identify any change of pattern of emergency surgical admissions and treatments during weekends. Furthermore, we aimed at investigating the impact of the COVID-19 pandemic on the alleged “weekend effect”. Methods The database of the CovidICE-International Study was interrogated, and 6263 patients were selected for analysis. Non-trauma, 18+ yo patients admitted to 45 emergency surgery units in Europe in the months of March–April 2019 and March–April 2020 were included. Demographic and clinical data were anonymised by the referring centre and centrally collected and analysed with a statistical package. This study was endorsed by the Association of Italian Hospital Surgeons (ACOI) and the World Society of Emergency Surgery (WSES). Results Three-quarters of patients have been admitted during workdays and only 25.7% during weekends. There was no difference in the distribution of gender, age, ASA class and diagnosis during weekends with respect to workdays. The first wave of the COVID pandemic caused a one-third reduction of emergency surgical admission both during workdays and weekends but did not change the relation between workdays and weekends. The treatment was more often surgical for patients admitted during weekends, with no difference between 2019 and 2020, and procedures were more often performed by open surgery. However, patients admitted during weekends had a threefold increased risk of laparoscopy-to-laparotomy conversion (1% vs. 3.4%). Hospital stay was longer in patients admitted during weekends, but those patients had a lower risk of readmission. There was no difference of the rate of rescue surgery between weekends and workdays. Subgroup analysis revealed that interventional procedures for hot gallbladder were less frequently performed on patients admitted during weekends. Conclusions Our analysis revealed that demographic and clinical profiles of patients admitted during weekends do not differ significantly from workdays, but the therapeutic strategy may be different probably due to lack of availability of services and skillsets during weekends. The first wave of the COVID-19 pandemic did not impact on this difference.

Bariatric surgery: to bleed or not to bleed? This is the question

“…Early postoperative bleeding is linked to longer hospitalization, major complications (such as sepsis and organ failure), reoperation and mortality [20][21][22][23]. Therefore, there is a need for preventive strategies in bariatric surgery due to the severe consequences of early postoperative.…”

The patterns and changes of general surgical presentations during the first wave COVID-19 pandemic at a metropolitan Sydney hospital

“…A multicentre study during the first wave of the pandemic reported a one-third reduction of emergency surgical admissions both during workdays and weekends. 9 Whereas, a Scottish study reported a significant increase in severe appendicitis resulting in greater proportion of emergency surgery and operative time. 10 Additionally, a regional New Zealand study reported patients with appendicitis were 15.1 years younger their counterparts (21.5 vs. 36.6, p<0.01), had a longer onset of symptoms During the first wave, Bankstown-Lidcombe hospital was a relatively spared centre like many other major Australian hospitals as resources were re-allocated towards major COVID-19 hospitals for expectant management of cases.…”

Understanding COVID-19 reporting behaviour to support political decision-making: a retrospective cross-sectional study of COVID-19 data reported to WHO

“…16 The term 'weekend effect' has been described as a suspected epidemiological effect causing substandard care during weekends due to higher workload and lower capacities of the healthcare system compared with workdays. 39 A 'weekend effect' has been described for other medical areas such as provision of emergency surgery or appropriate antibiotic prescription. [39][40][41][42] Higher reporting of COVID-19 case counts from Tuesday to Friday and day of week fluctuations have also been reported by regional studies and were attributed to temporal changes in laboratory testing and use of healthcare facilities as well as reporting delays.…”

“…39 A 'weekend effect' has been described for other medical areas such as provision of emergency surgery or appropriate antibiotic prescription. [39][40][41][42] Higher reporting of COVID-19 case counts from Tuesday to Friday and day of week fluctuations have also been reported by regional studies and were attributed to temporal changes in laboratory testing and use of healthcare facilities as well as reporting delays. 43 44 Thus, for frequently repeated decision processes like ad hoc travel restrictions, it seems to be reasonable to use case counts reported in the middle of the week for ad hoc political decision-making to avoid underestimation of case counts.…”