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It's become something of a cliché to say that weekends are dangerous times to be in the hospital, and now a Johns Hopkins study warns that the "weekend effect" also applies to children undergoing emergency surgery.

The study found that children who undergo simple emergency surgeries, such as hernia repairs or appendix removals, on weekends are more likely to suffer complications and even die than children getting the same kind of treatment during the week.

The Johns Hopkins Children's Center team says that although the number of deaths was small, the marked difference in death and risk of other complications calls for an in-depth examination of possible after-hours safety lapses and clinical glitches.

"Numerically speaking, the number of deaths was quite small, but even a single preventable death is one too many. This demands that we examine any factors that may cause or contribute to such occurrences and find ways to prevent them," said senior investigator Fizan Abdullah, M.D., Ph.D., a pediatric surgeon at the Johns Hopkins Children's Center.

"Hospitals must tease out factors such as how many people were there in the OR and ER, how many nurses were on a specific unit, what imaging was done and how soon, and then correlate all these with how well patients do after surgery," Abdullah said.

Study details

The research findings, published in the July issue of the Journal of Pediatric Surgery, are based on an analysis of 22 years' worth of surgical records involving nearly 440,000 pediatric admissions nationwide.

Specifically, children who underwent urgent or emergency procedures on weekends were 63 percent more likely to die than those treated during the week, the study showed. The investigators emphasize that an individual patient's risk of dying was minuscule and the actual deaths attributable to the weekend effect were very few — 30 over the 22 years.

Although the reasons for this weekend effect were not part of the study, the researchers say some possible factors that may fuel the higher risk include decreased weekend staffing, slower response times and decreased availability of certain imaging and lab tests.

The surgeries examined in the study are considered generally safe and relatively simple and included appendix removal, hernia repairs, draining and cleaning of infected wounds, bone fracture treatment, and surgeries to drain excess fluid in the brain. Overall, cases that showed up at the emergency room on weekends were no more severe than weekday cases, so the conditions themselves did not fuel the higher complication and death risk, the researchers say. The disparity in outcomes persisted even after researchers adjusted their analysis to account for any possible differences in disease severity.

"These are provocative findings and, we hope, a conversation starter," says study lead author Seth Goldstein, M.D., a pediatric surgery resident at Johns Hopkins. "Our next step is to understand the what, how and why behind this alarming disparity."

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