HOW DO HOLIDAYS IMPACT TREATMENT OF SURGICAL EMERGENCIES?
ANSWERS FROM A STATEWIDE PATEINT DATABASE
JF Bradley 3rd MD, KB Williams MD, AL Walters MS, BA Wormer MD, KT Dacey MHA, RF
Sing DO, VA Augenstein MD, BT Heniford MD – Carolinas Medical Center, Charlotte, NC
Background: The purpose of this study is to examine if the presence of a major holiday impacts
outcomes of common General Surgery pathology and associated operations.
Methods: The North Carolina Patient Data System was queried for patients with acute
appendicitis (APPY), cholecystitis (CHOLE), and small bowel obstruction (SBO) from 20062010 based on ICD-9 coding. Holidays (Christmas, Christmas Eve, Thanksgiving, July 4th,
Easter, and New Year’s, Memorial, and Labor day) and weekday outcomes were evaluated by
disease process (APPY, CHOLE, SBO). Outcomes included length of stay (LOS), ICU stay,
time to operative intervention, complications and mortality.
Results: A total of 81,473 patients met inclusion criteria. There were 79,634 weekday patients
and 1839 holiday patients. In the APPY group there were no differences in patient age or gender
(see table). LOS, percent ICU stay, complications and mortality was also similar (p>0.05). For
CHOLE, the weekday patients were slightly older than holiday (p=0.03) and time to operation
was shorter for the weekday group (1.5 vs 1.8 days; p<0.0001). However, LOS, ICU stay, and
mortality were similar (p>0.05) with fewer overall complications in the holiday group (p=0.005).
In the SBO group, patients had similar age, gender, days to operation, and ICU stay (p>0.05).
However, the weekday group had a longer LOS (8.4 vs 6.7; p<0.0001) and higher complication
rate (16% vs 12.3%; p=0.006), but similar mortality.
Conclusion: Outcomes of patients admitted with acute General Surgical pathology, including
appendicitis, cholecystitis and SBO, are not adversely affected when presenting on holidays
compared to those presenting on weekdays.
Table: Weekday vs Holiday
Appendicitis
Weekday
Number
Age (yrs)
Male %
Days to Op
LOS (days)
ICU Stay (%)
Complications (%)
Mortality
21,958
34.3±20.2
56.6
0.2±0.8
2.9±3.2
5.6
8.4
0.2
Holiday
Cholecystitis
Weekday
Holiday
575
23,844
507
334.5±20.7 55.5±19.6 53.6±20.1*
53.8
37.30
40.6
0.2±0.6
1.5±4.0
1.8±1.9*
2.7±2.7
5.0±6.7
4.4±3.8
5.6
19.0
16.0
6.8
9.3
5.7*
0.2
1.3
0.4
*Significant when compared to weekday (p<0.05)
SBO
Weekday
Holiday
33,832
757
61.0±19.7 61.4±19.4
42.7
46.0
2.6±6.6
2.4±3.5
8.4±14.7 6.7±9.4*
23.6
20.7
16.0
12.3*
4.9
4.8