Evaluating the weekend effect on mortality following major emergency general surgeries at a teaching hospital: a 7-year retrospective cohort study

BACKGROUND: The weekend effect refers to the observation that patients admitted to hospitals on weekends tend to experience poorer clinical outcomes compared to those admitted on weekdays. This study aimed to investigate whether undergoing major emergent general surgery on weekends is associated with higher 30-day mortality rates at a teaching hospital in Nablus, West Bank, between January 2017 and September 2023. METHODS: This retrospective cohort study included patients aged 18-64 years who underwent major emergent general surgery between January 1, 2017, and September 30, 2023. The primary endpoint was 30-day mortality. Secondary variables included length of hospital stay, time from admission to surgery, 30-day readmission, comorbidity burden (Age-adjusted Charlson Comorbidity Index, ACCI), and American Society of Anesthesiologists (ASA) classification. Patients aged ≥ 65 years were excluded due to higher baseline postoperative mortality risk. A total of 256 patients met the inclusion criteria. Patients were grouped according to the timing of surgery: weekend versus weekday. Non-parametric Chi-square and Mann-Whitney U tests were used for statistical comparisons, with a p-value < 0.05 considered statistically significant. RESULTS: Among 256 patients (mean age 38.8 years, 69.5% male), the most common surgical indications were bowel obstruction (32.4%) and hollow viscus perforation (27.0%). The overall 30-day mortality was 12.1%, with no significant differences between weekday and weekend surgeries in mortality, readmission, or length of stay. A higher comorbidity burden, defined by an Age-adjusted Charlson Comorbidity Index ≥ 3, was significantly associated with increased mortality, while age, American Society of Anesthesiologists score, diagnosis type, and admission day were not independent predictors. CONCLUSION: Weekend surgery was not associated with worse outcomes compared with weekday surgery. Consistent consultant availability may explain the absence of a weekend effect, while comorbidity burden remained the strongest predictor of postoperative mortality. Further multicenter prospective studies are needed to confirm these findings and explore the influence of staffing and system-level factors.