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Multicenter Study
. 2022 Apr 29;17(1):22.
doi: 10.1186/s13017-022-00425-z.

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

Giovanni D Tebala  1   2 , Marika S Milani  3 , Roberto Cirocchi  4 , Mark Bignell  5 , Giles Bond-Smith  5 , Christopher Lewis  5 , Vanni Agnoletti  6 , Marco Catarci  7 , Salomone Di Saverio  8 , Gianluigi Luridiana  9 , Fausto Catena  10 , Marco Scatizzi  11 , Pierluigi Marini  12 ; CovidICE-International Collaborative
Collaborators, Affiliations
Multicenter Study

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

Giovanni D Tebala et al. World J Emerg Surg. .

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.

Keywords: Emergency surgery; Hot gallbladder; Weekend effect.

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Conflict of interest statement

The authors declare that they have no competing interests. All authors certify that they have no affiliations with or involvement in any organisation or entity with any financial or non-financial interest in the subject matter or materials discussed in this manuscript.

Figures

Fig. 1
Fig. 1
Admissions by period (March–April 2019 vs. March–April 2020) and day of the week
Fig. 2
Fig. 2
Admissions per day of the week, seven most common diagnoses. The category “hot gallbladder” includes acute cholecystitis and intractable biliary colic. SBO small bowel obstruction, CRC colorectal cancer
See this image and copyright information in PMC

References

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