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

Author

Giovanni D. Tebala, Marika S. Milani, Roberto Cirocchi, Mark Bignell, Giles Bond-Smith, Christopher Lewis, Vanni Agnoletti, Marco Catarci, Salomone Di Saverio, Gianluigi Luridiana, Fausto Catena, Marco Scatizzi, Pierluigi Marini, and the CovidICE-International Collaborative

Subjects
Weekend effect, Emergency surgery, Hot gallbladder, Surgery, RD1-811, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

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.

Published
2022
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2. The weekend effect on the provision of Emergency Surgery before and during the COVID-19 pandemic: case–control analysis of a retrospective multicentre database.

Author

Tebala, Giovanni D., Milani, Marika S., Cirocchi, Roberto, Bignell, Mark, Bond-Smith, Giles, Lewis, Christopher, Agnoletti, Vanni, Catarci, Marco, Di Saverio, Salomone, Luridiana, Gianluigi, Catena, Fausto, Scatizzi, Marco, Marini, Pierluigi, the CovidICE-International Collaborative, Lo Dico, R., Stracqualursi, A., Russo, G., D'Errico, S., Cianci, P., and Restini, E.

Subjects
*AUDITING, *LENGTH of stay in hospitals, *OPERATIVE surgery, *TIME, *MEDICAL care, *PATIENTS, *CASE-control method, *RETROSPECTIVE studies, *ACQUISITION of data, *SURGERY, *HOSPITAL admission & discharge, *GALLBLADDER diseases, *EMERGENCY medical services, *MEDICAL records, *LAPAROSCOPY, *ABDOMINAL surgery, *DESCRIPTIVE statistics, *COVID-19 pandemic
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. [ABSTRACT FROM AUTHOR]

Published
2022
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3. The weekend effect on the provision of Emergency Surgery before and during the COVID-19 pandemic: case-control analysis of a retrospective multicentre database

Author

Tebala G. D., Milani M. S., Cirocchi R., Bignell M., Bond-Smith G., Lewis C., Agnoletti V., Catarci M., Di Saverio S., Luridiana G., Catena F., Scatizzi M., Marini P., Lo Dico R., Stracqualursi A., Russo G., D'Errico S., Cianci P., Restini E., Scialandrone G., Guercioni G., Martinez G., Pezzolla A., Altomare D. F., Picciariello A., Trigiante G., Dibra R., Papagni V., Righetti C., Polastri R., Andreuccetti J., Pignata G., D'Alessio R., Arici E., Canfora I., Cillara N., Deserra A., Sechi R., Bianco F., Gili S., Cappiello A., Incollingo P., Biloslavo A., Bellio G., Germani P., De Manzini N., Buiatti M., Paladino F. P., Sasia D., Borghi F., Testa V., Giraudo G., Allisiardi F., Giuffrida M. C., Gerosa M., Fogliati A., Maggioni D., Fabbri N., Feo C. V., Bianchini E., Panzini I., Lizzi V., Tricarico F. G., Di Gioia G., Melino R., Tartaglia N., Ambrosi A., Pavone G., Pacilli M., Vovola F., Belli F., Barberis A., Azzinnaro A., Coratti A., Benigni R., Berti S., Saracco M., Gennai A., Dova L., Farfaglia R., Pata G., Arizzi V., Pandolfo G., Frontali A., Danelli P., Ferrario L., Guerci C., Mariani N. M., Pisani Ceretti A., Nicastro V., Opocher E., Gozzo D., Casoni Pattacini G., Castriconi M., Amendola A., Gaudiello M., Palomba G., Petracca G. L., Perrone G., Giuffrida M., Moretto G., Impellizzeri H., Casaril A., Filosa M., Caizzone A., Agrusti S., Cattaneo G. M., Capelli P., Muratore A., Calabro M., Pipitore Federico N., Cuzzola B., Danna R., Murgese A., Coccolini F., Pieroni E., Chiarugi M., Tartaglia D., Giannessi S., Somigli R., Trafeli M., Fedi M., De Vincenti R., Guariniello A., Grande M., Bagaglini G., Pirozzi B., Guida A. M., Ingallinella S., Don C. P., Siragusa L., Capone O., Cerbo D., Santoro E., Pende V., Fassari A., Mingoli A., Brachini G., Cirillo B., Zambon M., Cicerchia P., Meneghini S., Sapienza P., Puzzovio A., La Torre F., Fransvea P., Di Grezia M., Sganga G., Armellino M. F., Ioia G., Rampone B., Della Corte M., Fleres F., Clarizia G., Bordoni P., Spolini A., Franzini M., Grechi A., Suppo M., Bono D., Scaglione D., Cotsoglou C., Paleini S., Chierici A. P., Uccelli M., Olmi S., Cesana G., Tenreiro N., Marcal A., Martins D., Leal C., Vieira B., Ugarte-Sierra B., Vincene-Rodriguez I., Duran-Ballesteros M., Sanz-Larrainzar A., Ibanez-Aguirre F. J., Yanez-Benites C., Talal I., Blas J. L., Garau R., Clark-Stuart S., Wallace A., Di Carlo A., Wisnia E., Ehsan K., Beck-Sanders K., Godson E., Campbell P., Ahmad R., Ali R., Aswani S. S., Barza A., Carrillo C., Dawani A., Dey A., Elserafy A., Gaspar D., Lazzareschi L., Patel M., Shabana A., Shams M., Shams O., Slack Z., Tebala, Giovanni D, Milani, Marika S, Cirocchi, Roberto, Bignell, Mark, Bond-Smith, Gile, Lewis, Christopher, Agnoletti, Vanni, Catarci, Marco, Di Saverio, Salomone, Luridiana, Gianluigi, Catena, Fausto, Scatizzi, Marco, Marini, Pierluigi, de Manzini, Nicolo', Tebala G.D., Milani M.S., Cirocchi R., Bignell M., Bond-Smith G., Lewis C., Agnoletti V., Catarci M., Di Saverio S., Luridiana G., Catena F., Scatizzi M., Marini P., Lo Dico R., Stracqualursi A., Russo G., D'Errico S., Cianci P., Restini E., Scialandrone G., Guercioni G., Martinez G., Pezzolla A., Altomare D.F., Picciariello A., Trigiante G., Dibra R., Papagni V., Righetti C., Polastri R., Andreuccetti J., Pignata G., D'Alessio R., Arici E., Canfora I., Cillara N., Deserra A., Sechi R., Bianco F., Gili S., Cappiello A., Incollingo P., Biloslavo A., Bellio G., Germani P., De Manzini N., Buiatti M., Paladino F.P., Sasia D., Borghi F., Testa V., Giraudo G., Allisiardi F., Giuffrida M.C., Gerosa M., Fogliati A., Maggioni D., Fabbri N., Feo C.V., Bianchini E., Panzini I., Lizzi V., Tricarico F.G., Di Gioia G., Melino R., Tartaglia N., Ambrosi A., Pavone G., Pacilli M., Vovola F., Belli F., Barberis A., Azzinnaro A., Coratti A., Benigni R., Berti S., Saracco M., Gennai A., Dova L., Farfaglia R., Pata G., Arizzi V., Pandolfo G., Frontali A., Danelli P., Ferrario L., Guerci C., Mariani N.M., Pisani Ceretti A., Nicastro V., Opocher E., Gozzo D., Casoni Pattacini G., Castriconi M., Amendola A., Gaudiello M., Palomba G., Petracca G.L., Perrone G., Giuffrida M., Moretto G., Impellizzeri H., Casaril A., Filosa M., Caizzone A., Agrusti S., Cattaneo G.M., Capelli P., Muratore A., Calabro M., Pipitore Federico N., Cuzzola B., Danna R., Murgese A., Coccolini F., Pieroni E., Chiarugi M., Tartaglia D., Giannessi S., Somigli R., Trafeli M., Fedi M., De Vincenti R., Guariniello A., Grande M., Bagaglini G., Pirozzi B., Guida A.M., Ingallinella S., Don C.P., Siragusa L., Capone O., Cerbo D., Santoro E., Pende V., Fassari A., Mingoli A., Brachini G., Cirillo B., Zambon M., Cicerchia P., Meneghini S., Sapienza P., Puzzovio A., La Torre F., Fransvea P., Di Grezia M., Sganga G., Armellino M.F., Ioia G., Rampone B., Della Corte M., Fleres F., Clarizia G., Bordoni P., Spolini A., Franzini M., Grechi A., Suppo M., Bono D., Scaglione D., Cotsoglou C., Paleini S., Chierici A.P., Uccelli M., Olmi S., Cesana G., Tenreiro N., Marcal A., Martins D., Leal C., Vieira B., Ugarte-Sierra B., Vincene-Rodriguez I., Duran-Ballesteros M., Sanz-Larrainzar A., Ibanez-Aguirre F.J., Yanez-Benites C., Talal I., Blas J.L., Garau R., Clark-Stuart S., Wallace A., Di Carlo A., Wisnia E., Ehsan K., Beck-Sanders K., Godson E., Campbell P., Ahmad R., Ali R., Aswani S.S., Barza A., Carrillo C., Dawani A., Dey A., Elserafy A., Gaspar D., Lazzareschi L., Patel M., Shabana A., Shams M., Shams O., and Slack Z.

Subjects
Hot gallbladder, education, Weekend effect, COVID-19, Settore MED/18 - Chirurgia Generale, Retrospective Studie, Case-Control Studies, Emergency surgery, Hospital Mortality, Humans, Retrospective Studies, Pandemics, Emergency Medicine, Surgery, Case-Control Studie, Human
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.

Published
2022

4. Financial implications of laparoscopic hot gallbladder service in a nontertiary District General Hospital.

Author

Bhattacharya S, Richardson T, Naidoo G, Gillick K, Haddad S, Ghosh C, and Brereton P

Subjects
Adult, Aged, Aged, 80 and over, Cholecystitis economics, Cholecystitis surgery, Female, Hospital Costs statistics & numerical data, Humans, Length of Stay economics, Male, Middle Aged, Retrospective Studies, Cholecystectomy, Laparoscopic economics, Hospitals, District economics, Hospitals, General economics
Abstract

Introduction: The service of providing index admission laparoscopic cholecystectomy (IALC), as recommended by NIC guidelines, often falls short in nontertiary centres because of a combination of limited resources and financial constraints., Methods: This retrospective study in a single-centre District General Hospital included 50 patients, eligible to undergo IALC, and calculated potential savings from performing IALC on the day of admission by considering admission tariffs, bed, and operating costs., Results: The IALC was provided in 19 patients (38%), with a mean delay from admission to operation of (median) 3 days. Mean surplus tariff was £1421 and £1571 in IALC and non-IALC groups, respectively. Performing immediate IALC (on the day of admission) for acute cholecystitis (AC) is predicted to increase mean surplus tariff to £2132 per patient, raising total predicted annual surplus by £53 000. Immediate IALC is also predicted to reduce waiting time for day-case LC by freeing up 53 day-case slots, attracting additional £95 600 annually, along with freeing up many inpatient bed days., Conclusions: This study demonstrates that reduction of preoperative stay in AC by expediting operations in every eligible patient promises significant surplus revenue. Additional advantages include reducing inpatient bed days and freeing up operating lists that are otherwise taken up by patients for interval cholecystectomy., (© 2018 John Wiley & Sons, Ltd.)

Published
2018
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