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Postpone Your Operation to a Weekday, or Look for an Experienced Surgeon: Comment on “Worse Outcomes in Patients Undergoing Urgent Surgery for Left-Sided Diverticulitis Admitted on Weekends vs Weekdays”

Postpone Your Operation to a Weekday, or Look for an Experienced Surgeon: Comment on “Worse... Emergency operations performed on weekends are associated with more complications than those performed on weekdays. The article by Worni et al1 highlights the problem of the influence of available surgical expertise on the postoperative outcomes of a very common disease. They analyzed data on more than 31 000 patients with left-sided diverticulitis, categorized into 2 groups admitted on weekends vs weekdays. The authors showed that admission during the weekend significantly increased the risk of postoperative complications and the frequency of performance of a Hartmann procedure. The key question remains why surgery for such a common disease as left-sided diverticulitis is significantly more dangerous during a weekend admission. Work hour restrictions do not seem to have a negative influence on mortality and morbidity in surgical patients.2 However, reduced experience owing to restricted working hours may negatively influence the practical skills of younger surgeons, resulting in more limited surgery (eg, a Hartmann procedure being performed instead of a primary anastomosis) and an increase in complications related to that surgery. Do we need more specialized surgeons to overcome this problem, or is it necessary to change our education system? In the end, quality is expensive, and our society has to decide if it is desirable and necessary to have the best surgical quality available all the time, especially when considering that health care costs will dramatically increase. It would be relevant to analyze additional large databases, asking similar questions about the outcomes of other common diseases (eg, appendicitis, cholecystitis, and strangulated hernias) and studying the effect of weekend admission on these illnesses. Back to top Article Information Correspondence: Dr Metzger, Department of Surgery, Cantonal Hospital Lucerne, Spitalstrasse, CH-6000 Lucerne 16, Switzerland (juerg.metzger@luks.ch). Financial Disclosure: None reported. References 1. Worni M, Schudel IM, Østbye T, et al. Worse outcomes in patients undergoing urgent surgery for left-sided diverticulitis admitted on weekends vs weekdays: a population-based study of 31 832 patients. Arch Surg. 2012;147(7):soa120020649-655Google Scholar 2. Jamal MH, Doi SA, Rousseau M, et al. Systematic review and meta-analysis of the effect of North American working hours restrictions on mortality and morbidity in surgical patients. Br J Surg. 2012;99(3):336-34422241280PubMedGoogle ScholarCrossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Postpone Your Operation to a Weekday, or Look for an Experienced Surgeon: Comment on “Worse Outcomes in Patients Undergoing Urgent Surgery for Left-Sided Diverticulitis Admitted on Weekends vs Weekdays”

Archives of Surgery , Volume 147 (7) – Jul 1, 2012

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References (2)

Publisher
American Medical Association
Copyright
Copyright © 2012 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.2012.845
Publisher site
See Article on Publisher Site

Abstract

Emergency operations performed on weekends are associated with more complications than those performed on weekdays. The article by Worni et al1 highlights the problem of the influence of available surgical expertise on the postoperative outcomes of a very common disease. They analyzed data on more than 31 000 patients with left-sided diverticulitis, categorized into 2 groups admitted on weekends vs weekdays. The authors showed that admission during the weekend significantly increased the risk of postoperative complications and the frequency of performance of a Hartmann procedure. The key question remains why surgery for such a common disease as left-sided diverticulitis is significantly more dangerous during a weekend admission. Work hour restrictions do not seem to have a negative influence on mortality and morbidity in surgical patients.2 However, reduced experience owing to restricted working hours may negatively influence the practical skills of younger surgeons, resulting in more limited surgery (eg, a Hartmann procedure being performed instead of a primary anastomosis) and an increase in complications related to that surgery. Do we need more specialized surgeons to overcome this problem, or is it necessary to change our education system? In the end, quality is expensive, and our society has to decide if it is desirable and necessary to have the best surgical quality available all the time, especially when considering that health care costs will dramatically increase. It would be relevant to analyze additional large databases, asking similar questions about the outcomes of other common diseases (eg, appendicitis, cholecystitis, and strangulated hernias) and studying the effect of weekend admission on these illnesses. Back to top Article Information Correspondence: Dr Metzger, Department of Surgery, Cantonal Hospital Lucerne, Spitalstrasse, CH-6000 Lucerne 16, Switzerland (juerg.metzger@luks.ch). Financial Disclosure: None reported. References 1. Worni M, Schudel IM, Østbye T, et al. Worse outcomes in patients undergoing urgent surgery for left-sided diverticulitis admitted on weekends vs weekdays: a population-based study of 31 832 patients. Arch Surg. 2012;147(7):soa120020649-655Google Scholar 2. Jamal MH, Doi SA, Rousseau M, et al. Systematic review and meta-analysis of the effect of North American working hours restrictions on mortality and morbidity in surgical patients. Br J Surg. 2012;99(3):336-34422241280PubMedGoogle ScholarCrossref

Journal

Archives of SurgeryAmerican Medical Association

Published: Jul 1, 2012

Keywords: diverticulitis,surgical procedures, operative,surgery specialty,surgeons,weekend

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