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Urgent Laparoscopic Cholecystectomy -- Is There a Weekend Effect?
Gurdeep S. Matharoo, John Afthinos*, Karen E. Gibbs
Staten Island University Hospital, Staten Island, NY
Introduction: There is concern over whether the quality of care delivered over the weekend is the same as during the week. Urgent surgery for left-sided diverticulitis and Crohn's disease has been shown to have disparate outcomes depending on whether they were performed on the weekend or weekday. This has been termed the "weekend effect". We sought to determine if there was a weekend effect with regards to urgent laparoscopic cholecystectomies (LC).
Methods: The Nationwide Inpatient Data Sample (NIS) was queried for the years 2005 to 2009 for urgent, non-elective laparoscopic cholecystectomies performed within 24 hours of admission. We selected cases of acute cholecystitis, with or without concomitant choledocholithiasis. Cases of malignancy and choledocholithiasis without cholecystitis were excluded. The remaining patients were examined for age and comorbid conditions. We then evaluated for length of stay and overall morbidity and mortality. Univariate and multivariate logistic regression analyses were then performed to identify factors predicting post-operative morbidity and mortality.
Results: A total of 586,444 laparoscopic cholecystectomies were performed, of which 122,958 (19%) were performed on the weekend. Among the most significant predictors of mortality were CHF, severe liver disease, CKD and COPD. Overall morbidity (2.75% vs. 2.43%, p < 0.001) and mortality (0.18% vs. 0.14%, p < 0.01) were higher in the weekday group as compared to the weekend group. See Tables.
Conclusion: We found a higher rate of morbidity and mortality in patients who undergo an operation on the weekday. Multivariate analysis reveals that the higher rate of complications and death seen within this group is due to the higher prevalence of severe comorbid conditions such as COPD, CHF, CKD and severe liver disease. Given that the timing of LC was not an independent predictor of mortality, we conclude that there is no weekend effect for urgently performed cholecystectomies.
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