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Out‐of‐office hours’ elective surgical intensive care admissions and their associated complications
Author(s) -
Morgan David J. R.,
Ho Kwok Ming,
Ong Yang Jian,
Kolybaba Marlene L.
Publication year - 2017
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/ans.14027
Subject(s) - medicine , staffing , elective surgery , emergency medicine , seniority , retrospective cohort study , surgery , nursing , political science , law
Background The ‘weekend’ effect is a controversial theory that links reduced staffing levels, staffing seniority and supportive services at hospitals during ‘out‐of‐office hours’ time periods with worsening patient outcomes. It is uncertain whether admitting elective surgery patients to intensive care units ( ICU ) during ‘out‐of‐office hours’ time periods mitigates this affect through higher staffing ratios and seniority. Methods Over a 3‐year period in Western Australia's largest private hospital, this retrospective nested‐cohort study compared all elective surgical patients admitted to the ICU based on whether their admission occurred ‘in‐office hours’ (Monday–Friday 08.00–18.00 hours) or ‘out‐of‐office hours’ (all other times). The main outcomes were surgical complications using the Dindo‐Clavien classification and length‐of‐stay data. Results Of the total 4363 ICU admissions, 3584 ICU admissions were planned following elective surgery resulting in 2515 (70.2%) in‐office hours and 1069 (29.8%) out‐of‐office hours elective ICU surgical admissions. Out‐of‐office hours ICU admissions following elective surgery were associated with an increased risk of infection ( P = 0.029), blood transfusion ( P = 0.020), total parental nutrition ( P < 0.001) and unplanned re‐operations ( P = 0.027). Out‐of‐office hours ICU admissions were also associated with an increased hospital length‐of‐stay, with (1.74 days longer, P < 0.0001) and without (2.8 days longer, P < 0.001) adjusting for severity of acute and chronic illnesses and inter‐hospital transfers (12.3 versus 9.8%, P = 0.024). Hospital mortality (1.2 versus 0.7%, P = 0.111) was low and similar between both groups. Conclusion Out‐of‐office hours ICU admissions following elective surgery is common and associated with serious post‐operative complications culminating in significantly longer hospital length‐of‐stays and greater transfers with important patient and health economic implications.