Weekend carotid endarterectomies are not associated with a greater risk of stroke and/or death in Australia and New Zealand

Background: Data from multiple surgical studies and settings have reported an increase in adverse events in patients admitted or treated on weekends. The aim of this study was to investigate short-term outcomes for patients undergoing carotid endarterectomy (CEA) in Australia and New Zealand based on the day of surgery. Methods: This is a retrospective observational cohort study. Analysis of 7,857 CEAs recorded for more than 4 years in the Australasian Vascular Audit database was performed. Multivariate logistic regression was used to compare the following outcomes between CEAs performed during the week and on the weekend: (1) in-hospital stroke and/or death; (2) other postoperative complications; and (3) shorter (2 days or less) length of stay (LOS). Results: A total of 7,857 CEAs were recorded, with significantly more procedures performed during the week (n = 7,333, P P = 0.294 and P = 0.806, respectively). However, there was a significant difference in LOS for procedures performed during the weekend, with more of these patients being discharged within 2 days compared with procedures performed during the week (56.8% vs. 51.5%; P = 0.003). Multivariable logistic regression found no effect of day of the week on the odds of postoperative stroke and/or death (P = 0.685). Day of surgery was also not associated with greater odds of other complications (P = 0.925). However, CEAs performed by nonconsultants had significantly lower adjusted odds of other complications (3.1% vs. 4.1%; P = 0.033). The adjusted odds of having a shorter LOS were significantly greater for operations taking place on the weekend (P = 0.003). Conclusions: In Australia and New Zealand, there appears to be no disadvantage to performing CEA on the weekend, in terms of stroke and/or death. Level of experience of the primary operator does not affect rates of stroke and/or death after CEA. Weekend CEA is associated with a shorter hospital LOS.</p

Rural centres do not have a higher prevalence of post-operative complications than urban centres: a retrospective analysis of a mortality audit

BACKGROUND: The trend towards centralization of surgical care from rural to high-volume centres is based on studies showing better outcomes for patients requiring complex surgical procedures. However, evidence that this also applies to less complex procedures is lacking. This study therefore aimed to determine whether there was a relationship between geographic location (rural versus urban) of surgical procedures of varying complexity and post-operative complications. METHODS: This was a retrospective cohort study examining all in-hospital deaths reported to the Australian and New Zealand Audit of Surgical Mortality (ANZASM) between 2009 and 2016. Multivariable logistic regression was used to ascertain interactive effects of location and complexity of surgical procedures on post-operative complications, adjusted for potential confounders. RESULTS: There was no interactive effect of hospital location and operation complexity on the occurrence of post-operative complications. Post-operative complications were reported in 2160 of 6963 (31%) patients who died post-surgery. Patients operated on in rural centres had lower risk profiles: younger, with lower American Society of Anesthesiologists grades and less likely to present with injury and circulatory diseases. Nonetheless, risk of post-operative complications did not differ between procedures performed in rural compared with urban hospitals. CONCLUSION: Results of this study suggest that a wide range of procedures may be safely performed in rural centres. Further prospective studies of unfiltered cohorts are warranted to validate these findings