Weekends at risk: Uncovering the impact of the weekend effect on emergency general surgery

Background: Weekend admissions have been proposed to be associated with the worst outcomes across varied patient populations and health care systems. However, there is a dearth of literature on weekend effects in low- and middle-income countries like Pakistan. This study aimed to assess the role of the “weekend effect” on the outcomes of emergency general surgery patients admitted to a tertiary care center in Pakistan. Methods: Data from adult patients with emergency general surgery conditions defined by the American Association for the Surgery of Trauma with primary index admissions from 2010 to 2019 from a tertiary care center in Pakistan were analyzed. The outcomes of interest were severe adverse events, in-patient mortality, and failure to rescue. Multiple logistic regression obtained an adjusted odds ratio with 95% confidence interval. Results: Records from 32,280 emergency general surgery patients showed that most patients were aged 41–60 years (38.60%) and were male (53.50%). Most patients (76.68%) were admitted on weekdays. Severe adverse events (40.01% vs 33.99%) and in-patient mortality (2.96% vs 2.25%) were significantly higher on weekends than weekdays but had no association with failure to rescue. The odds of severe adverse events (adjusted odds ratio: 1.23; 95% confidence interval: 1.16, 1.30) and in-patient mortality (adjusted odds ratio: 1.16; 95% confidence interval: 1.00, 1.37) were higher on weekends than on weekdays. Having no health care coverage was also a significant factor in the worst outcomes. Conclusion: Weekend admissions are associated with increased severe adverse events and mortality, indicating possible disparities in care quality during weekends. Strategies to improve weekend care could enhance outcomes. Further studies should control for case-mix differences by admission day.