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 Domenico Tebala, Marika Sharmayne Milani, Roberto Cirocchi, Mark Bignell, Giles Bond‐Smith, Christopher Alan Lewis, Vanni Agnoletti, Marco Catarci, Salomone Di Saverio, Gianluigi Luridiana, Fausto Catena, Marco Scatizzi, Pierluigi Marini, the CovidICE-International Collaborative, Réa Lo Dico, A Stracqualursi, Giuseppe Russo, Sara D’Errico, Pasquale Cianci, Enrico Restini, G. Scialandrone, Gianluca Guercioni, Gennaro Martinez, Angela Pezzolla, Donato F. Altomare, Arcangelo Picciariello, Giuseppe Trigiante, Rigers Dibra, Vincenzo Papagni, C. Righetti, Roberto Polastri, Jacopo Andreuccetti, Giusto Pignata, Rossella D’Alessio, Elisa Arici, Ilaria Canfora, Nicola Cillara, Antonello Deserra, Raffaele Sechi, Francesco Bianco, Simona Gili, Antonio Cappiello, Paola Incollingo, Alan Biloslavo, Gabriele Bellio, Paola Germani, Nicolò de Manzini, Marco Buiatti, Fabio P. Paladino, Diego Sasia, Felice Borghi, Valentina Testa, Giorgio Giraudo, Fabrizio Allisiardi, Maria Carmela Giuffrida, Martino Gerosa, Alessandro Fogliati, Dario Maggioni, Nicolò Fabbri, Carlo V. Feo, Erica Bianchini, Ilaria Panzini, Vincenzo Lizzi, Fausto Tricarico, Giovanni Di Gioia, Rocco Melino, Nicola Tartaglia, Antonio Ambrosi, Giovanna Pavone, Mario Pacilli, Fernanda Vovola, Fiorenza Belli, Andrea Barberis, Antonio Azzinnaro, Andrea Coratti, Roberto Benigni, Stefano Berti, Michele Saracco, Andrea Gennai, Laura Dova, Roberto Farfaglia, Giacomo Pata, Valeria Arizzi, G Pandolfo, Alice Frontali, Piergiorgio Danelli, Luca Ferrario, Claudio Guerci, Nicolò Maria Mariani, Andrea Pisani Ceretti, Vincenzo Nicastro, Enrico Opocher, Davide Gozzo, Gianmaria Casoni Pattacini, Maurizio Castriconi, Alfonso Amendola, Maria Gaudiello, Giuseppe Palomba, Fausto Catena, Gabriele Luciano Petracca
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.