Smith Charesa J, Sullivan Gwyneth A, Reiter Audra J, Tian Yao, Goldstein Seth D, Raval Mehul V
Division of Pediatric Surgery, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Northwestern Quality Improvement, Research, & Education in Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
Division of Pediatric Surgery, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
J Pediatr Surg. 2025 Jan;60(1):161937. doi: 10.1016/j.jpedsurg.2024.161937. Epub 2024 Sep 26.
Limited operating room availability constrains hospital scheduling capacity for elective surgical cases. Leveraging weekends for elective surgical cases could increase operative capacity but must be balanced with practical considerations. Our study aimed to characterize trends and outcomes for elective pediatric surgeries performed during weekends.
This retrospective cohort study used the Pediatric Health Information System database from 2016 to 2019 to identify surgeries in children <18 years of age from 38 hospitals. Six elective surgeries, commonly performed on the weekend, were selected for analysis. Trends in elective surgeries during weekends (Saturday or Sunday) were evaluated using the Mann-Kendall trend test. Multivariable regression models were used to compare complications and costs between weekend and weekday surgeries.
Of the 233,266 elective surgeries evaluated, 357 (0.15%) were performed during weekend hours. The proportion of surgeries performed on weekends was stable over time (p = 0.65). Following adjustment for clinicodemographic and hospital-level factors, no differences were observed when comparing weekend to weekday surgeries in terms of surgical complications [adjusted Odds Ratio: 1.59; 95% Confidence Interval (CI): 0.65-3.90; p = 0.32] or mortality (n = 1 in cohort). Weekend surgeries were associated a small additional cost compared to weekday surgeries (β-coefficient $312; 95% CI: $152 to $473; p < 0.01).
Elective pediatric surgeries performed during weekends were uncommon, stable in occurrence, and not associated with substantial increases in complications or costs compared to weekday surgeries. Increasing surgical capacity by extending into weekend scheduling merits further assessment of patient and provider satisfaction, unexpected human resource costs, and thoughtful case selection to ensure patient safety.
III.
Retrospective Cohort Study.
手术室可用时间有限限制了医院安排择期手术病例的能力。利用周末进行择期手术可增加手术量，但必须综合实际因素加以权衡。我们的研究旨在描述周末进行的择期小儿外科手术的趋势和结果。
这项回顾性队列研究使用了2016年至2019年的儿科健康信息系统数据库，以确定38家医院中18岁以下儿童的手术情况。选取了六种通常在周末进行的择期手术进行分析。使用曼-肯德尔趋势检验评估周末（周六或周日）择期手术的趋势。采用多变量回归模型比较周末手术和平日手术的并发症及费用。
在评估的233,266例择期手术中，357例（0.15%）在周末时段进行。周末进行的手术比例随时间保持稳定（p = 0.65）。在对临床人口统计学和医院层面因素进行调整后，比较周末手术和平日手术时，在手术并发症方面未观察到差异[调整后的优势比：1.59；95%置信区间（CI）：0.65 - 3.90；p = 0.32]，死亡率方面也无差异（队列中有1例死亡）。与平日手术相比，周末手术的费用略有增加（β系数为312美元；95% CI：152美元至473美元；p < 0.01）。
与平日手术相比，周末进行的择期小儿外科手术并不常见，发生率稳定，且并发症或费用并未大幅增加。通过延长至周末排班来增加手术量，值得进一步评估患者和医护人员的满意度、意外的人力资源成本以及谨慎的病例选择，以确保患者安全。
III级。
回顾性队列研究。
