The concept of “weekend effect”, that is, substandard healthcare during weekends, has never been fully demonstrated, and the different outcomes of emergency surgical patients admitted during weekends may be due to different conditions at admission and/or different therapeutic approaches. Aim of this international audit was to identify any change of pattern of emergency surgical admissions and treatments during weekends. Furthermore, we aimed at investigating the impact of the COVID-19 pandemic on the alleged “weekend effect”. The database of the CovidICE-International Study was interrogated, and 6263 patients were selected for analysis. Non-trauma, 18+ yo patients admitted to 45 emergency surgery units in Europe in the months of March–April 2019 and March–April 2020 were included. Demographic and clinical data were anonymised by the referring centre and centrally collected and analysed with a statistical package. This study was endorsed by the Association of Italian Hospital Surgeons (ACOI) and the World Society of Emergency Surgery (WSES). Three-quarters of patients have been admitted during workdays and only 25.7% during weekends. There was no difference in the distribution of gender, age, ASA class and diagnosis during weekends with respect to workdays. The first wave of the COVID pandemic caused a one-third reduction of emergency surgical admission both during workdays and weekends but did not change the relation between workdays and weekends. The treatment was more often surgical for patients admitted during weekends, with no difference between 2019 and 2020, and procedures were more often performed by open surgery. However, patients admitted during weekends had a threefold increased risk of laparoscopy-to-laparotomy conversion (1% vs. 3.4%). Hospital stay was longer in patients admitted during weekends, but those patients had a lower risk of readmission. There was no difference of the rate of rescue surgery between weekends and workdays. Subgroup analysis revealed that interventional procedures for hot gallbladder were less frequently performed on patients admitted during weekends. Our analysis revealed that demographic and clinical profiles of patients admitted during weekends do not differ significantly from workdays, but the therapeutic strategy may be different probably due to lack of availability of services and skillsets during weekends. The first wave of the COVID-19 pandemic did not impact on this difference.

中文翻译：

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周末对 COVID-19 大流行之前和期间提供急诊手术的影响：回顾性多中心数据库的病例对照分析

“周末效应”的概念，即周末医疗不达标的概念从未得到充分论证，周末入院的急诊外科患者的不同结局可能是由于入院条件不同和/或治疗方法不同所致。这次国际审计的目的是确定周末急诊手术入院和治疗模式的任何变化。此外，我们旨在调查 COVID-19 大流行对所谓的“周末效应”的影响。对 CovidICE-International 研究的数据库进行了查询，选择了 6263 名患者进行分析。包括在 2019 年 3 月至 4 月和 2020 年 3 月至 2020 年 4 月期间在欧洲 45 个急诊手术室收治的非创伤性、18 岁以上患者。人口统计和临床数据由转诊中心匿名，并通过统计包集中收集和分析。这项研究得到了意大利医院外科医生协会 (ACOI) 和世界急诊外科学会 (WSES) 的认可。四分之三的患者在工作日入院，只有 25.7% 在周末入院。周末工作日的性别、年龄、ASA等级和诊断分布没有差异。第一波 COVID 大流行导致工作日和周末急诊手术入院人数减少了三分之一，但并未改变工作日和周末之间的关系。对于周末入院的患者，治疗更多是手术治疗，2019 年和 2020 年之间没有差异，并且手术更经常通过开放手术进行。然而，周末入院的患者腹腔镜转开腹手术的风险增加了三倍（1% 对 3.4%）。周末入院的患者住院时间更长，但这些患者再入院的风险较低。周末和工作日抢救手术率无差异。亚组分析显示，对周末入院的患者进行热胆囊介入手术的频率较低。我们的分析显示，周末入院患者的人口统计学和临床​​特征与工作日没有显着差异，但治疗策略可能会有所不同，这可能是由于周末缺乏服务和技能组合。第一波 COVID-19 大流行并未影响这种差异。周末入院的患者腹腔镜转开腹手术的风险增加了三倍（1% 对 3.4%）。周末入院的患者住院时间更长，但这些患者再入院的风险较低。周末和工作日抢救手术率无差异。亚组分析显示，对周末入院的患者进行热胆囊介入手术的频率较低。我们的分析显示，周末入院患者的人口统计学和临床​​特征与工作日没有显着差异，但治疗策略可能会有所不同，这可能是由于周末缺乏服务和技能组合。第一波 COVID-19 大流行并未影响这种差异。周末入院的患者腹腔镜转开腹手术的风险增加了三倍（1% 对 3.4%）。周末入院的患者住院时间更长，但这些患者再入院的风险较低。周末和工作日抢救手术率无差异。亚组分析显示，对周末入院的患者进行热胆囊介入手术的频率较低。我们的分析显示，周末入院患者的人口统计学和临床​​特征与工作日没有显着差异，但治疗策略可能会有所不同，这可能是由于周末缺乏服务和技能组合。第一波 COVID-19 大流行并未影响这种差异。