Dataset Information

Weekend Surgical Admissions of Pediatric IBD Patients Have a Higher Risk of Complication in Hospitals Across the US.

ABSTRACT:

Background

Weekend surgical admissions to the hospital are associated with worse clinical outcomes when compared with weekday admissions. We aimed to evaluate the association of weekend admission and in-hospital complications for pediatric inflammatory bowel disease (IBD) hospitalizations requiring urgent abdominal surgery.

Methods

We performed a cross-sectional analysis of pediatric (18 years old and younger) IBD hospitalizations between 1997 and 2016 using the Kids' Inpatient Database (KID), a nationally representative database of pediatric hospitalizations. We included discharges with a diagnosis code for Crohn's disease (CD) or ulcerative colitis (UC) undergoing a surgical procedure within 48 hours of admission. We used logistic regression to evaluate the association of weekend admission and complications, controlling for confounding factors.

Results

Our study included a total of 3255 urgent surgical hospitalizations, representing 4950 hospitalizations nationwide. The risk difference for weekend CD surgical hospitalizations involving a complication vs weekday hospitalizations was 4%. Adjusted analysis demonstrated a 30% increased risk for complications associated with weekend CD hospitalizations compared with weekday hospitalizations (OR 1.3, 95% CI, 1.0-1.7). The risk difference for weekend UC hospitalizations involving a complication compared with the weekday hospitalizations was 7%. Adjusted analysis demonstrated a 70% increased risk of complication for UC weekend surgical hospitalizations compared with weekday hospitalizations (OR 1.7, 95% CI, 1.2-2.3).

Conclusion

Pediatric IBD hospitalizations involving urgent surgical procedures have higher rates of complications when admitted on the weekend vs the weekday. The outcome disparity requires further health services research and quality improvement initiatives to identify contributing factors and improve surgical outcomes.

SUBMITTER: Egberg MD

PROVIDER: S-EPMC6943686 | biostudies-literature | 2020 Jan

REPOSITORIES: biostudies-literature

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Publications

Weekend Surgical Admissions of Pediatric IBD Patients Have a Higher Risk of Complication in Hospitals Across the US.

Egberg Matthew D MD Galanko Joseph A JA Kappelman Michael D MD

Inflammatory bowel diseases 20200101 2

<h4>Background</h4>Weekend surgical admissions to the hospital are associated with worse clinical outcomes when compared with weekday admissions. We aimed to evaluate the association of weekend admission and in-hospital complications for pediatric inflammatory bowel disease (IBD) hospitalizations requiring urgent abdominal surgery.<h4>Methods</h4>We performed a cross-sectional analysis of pediatric (18 years old and younger) IBD hospitalizations between 1997 and 2016 using the Kids' Inpatient Da ...[more]

PMID: 31246248

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Project description:In adult patients with leukemia, weekend admission is associated with increased inpatient mortality. It is unknown whether weekend diagnostic admissions in pediatric patients with leukemia demonstrate similar adverse outcomes.To estimate adverse clinical outcomes associated with weekend admission in the first hospitalization of pediatric patients with newly diagnosed leukemia.This retrospective cohort study from 1999 to 2011 featured index hospital admissions identified from the Pediatric Health Information System database. Participants were children with newly diagnosed acute lymphoid leukemia or acute myeloid leukemia.Weekend (Saturday and Sunday) or weekday index admission.Inpatient mortality, length of inpatient stay, time to chemotherapy, and organ-system failure in index admission.A total of 10?720 patients with acute lymphoid leukemia and 1323 patients with acute myeloid leukemia were identified; 2009 patients (16.7%) were admitted on the weekend. While the total daily number of patients receiving intensive care unit-level care was constant regardless of the day of admission, these patients represented a larger percentage of total admissions on weekends. In adjusted analyses, patients admitted on the weekend did not have an increased rate of mortality during the first admission (odds ratio, 1.0; 95% CI, 0.8-1.6). Patients whose initial admission for leukemia occurred during a weekend had a significantly increased length of stay (1.4-day increase; 95% CI, 0.7-2.1), time to initiation of chemotherapy (0.36-day increase; 95% CI, 0.3-0.5), and risk for respiratory failure (odds ratio, 1.5; 95% CI, 1.2-1.7) after adjusting for demographics, severity of illness, and hospital-level factors.While pediatric patients with newly diagnosed leukemia admitted on weekends do not have higher mortality rates, they have a prolonged length of stay, increased time to chemotherapy, and higher risk for respiratory failure. Patients who are severely ill at presentation represent a higher proportion of weekend index admissions. Optimizing weekend resources by increasing staffing and access to diagnostic and therapeutic resources may help to reduce hospital length of stay across all weekend admissions and may also ensure the availability of comprehensive care for those weekend admissions with higher acuity.

Dataset Information

Weekend Surgical Admissions of Pediatric IBD Patients Have a Higher Risk of Complication in Hospitals Across the US.

Background

Methods

Results

Conclusion

Publications

Weekend Surgical Admissions of Pediatric IBD Patients Have a Higher Risk of Complication in Hospitals Across the US.

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