Investigating the weekend effect in decompressive thoracolumbar hemilaminectomy for acute intervertebral disc extrusion: An observational cohort study of 460 cases (2018–2023)

Daniel Low BVetMed, MRCVS, Scott Rutherford BVMS, CertSAS, DipECVS, MRCVS

Background

This study examines the "weekend effect" — poorer patient outcomes associated with weekend surgeries — in dogs undergoing decompressive thoracolumbar hemilaminectomy for acute thoracolumbar intervertebral disc extrusion (IVDE). Despite mixed evidence of the weekend effect in human medicine, its implications in veterinary medicine, particularly for conditions like acute IVDE which may require urgent care, remain understudied. The study hypothesizes that weekend surgeries may lead to worse patient outcomes compared to weekdays.

Methods

A retrospective observational cohort study was conducted using medical records from a UK surgical referral center, covering cases from February 2018 to August 2023. A total of 460 cases were reviewed, categorized into 401 weekday surgeries (Cohort WD) and 59 weekend surgeries (Cohort WE). Data collection focused on preoperative patient demographics, clinical data, postoperative outcomes with a minimum 28-day follow-up, and multivariable logistic regression analysis to model the odds of negative outcomes.

Results

Weekend surgeries showed a higher proportion of nonambulatory dogs preoperatively. Despite no significant differences in ambulatory status and deep-pain negative subgroups between cohorts, weekend surgeries were associated with a higher risk of not recovering ambulation and increased postoperative morbidity. However, no significant differences in other outcome measures were observed. The weekend surgery cohort had a 79.2% recovery of ambulation versus 91.6% for the weekday surgery cohort, with an adjusted odds ratio (OR) of 3.010 for not recovering ambulation and an adjusted OR of 2.015 for higher postoperative morbidity.

Limitations

The study acknowledges potential biases due to its retrospective nature, the single-center setting, and the inability to control for all confounding variables. Moreover, the results may not be generalizable across all veterinary settings due to variations in weekend staffing and operational practices.

Conclusions

The study presents evidence of a weekend effect in veterinary surgery for acute thoracolumbar IVDE, suggesting that surgeries performed over the weekend may result in poorer outcomes, such as higher morbidity and lower recovery rates of ambulation. These findings underscore the need for further investigation into the weekend effect and its implications for surgical decision-making and healthcare resource allocation in veterinary medicine.

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