• Virendra Rajendrakumar Desai, Andrew Jea, David D Gonda, Sandi Lam, and Thomas G Luerssen.
• Neurosurgery. 2015 Aug 1;62 Suppl 1:231.

IntroductionSeveral studies have indicated that 30-day morbidity and mortality risk is higher among pediatric and adult patients who are admitted on the weekends. This "weekend effect" has been observed among patients admitted with and for a variety of diagnoses and procedures, respectively, including myocardial infarction, pulmonary embolism, ruptured abdominal aortic aneurysm, stroke, peptic ulcer disease, and pediatric surgery. We sought to compare morbidity and mortality outcomes for emergent pediatric neurosurgical procedures done on the weekend or after-hours with emergent surgical procedures performed during regular weekday "business hours."MethodsWe conducted a retrospective collection of data. A total of 710 urgent or emergent neurosurgical procedures between December 1, 2011 and August 20, 2014 at Texas Children's Hospital in children less than 18 years of age were performed. These surgical occurrences were then stratified into 3 groups: weekday regular-hours; weekday after-hours; and weekend. By cross-referencing these events with our prospectively collected morbidity and mortality database, we examined the impact of the day and time on complication incidence. Outcome metrics were compared using logistic regression models.ResultsThe weekday regular-hours and the after-hours (weekday after-hours or weekends) surgery groups comprised 341 and 239 patients, and 434 and 276 procedures, respectively. There were no significant differences in the types of cases performed (P = .629) or the baseline preoperative health status as determined by ASA classifications (P = .220) between the 2 cohorts. After multivariate adjustment and Desai 4 regression, children undergoing emergency neurosurgical procedures during weekday after-hours and weekends were more likely to experience complications (P = .027).ConclusionWeekday after-hours and weekend emergent pediatric neurosurgical procedures are associated with significantly increased 30-day morbidity and mortality risk compared with procedures performed during weekday regular hours.

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