In a research article published by the well-respected British medical journal BMJ on May 28, 2013, the researchers reported that their review of all acute and specialist English hospitals carrying out elective surgery over three financial years, from 2008-09 to 2010-11, found that there was 44% higher odds of dying within thirty days of the procedure if the procedure was performed on a Friday and 82% higher odds of dying within thirty days of the procedure if the procedure was performed on a weekend, when compared to procedures performed on a Monday. Elective surgery odds of death were greater on a Saturday or Sunday when compared to a Friday.
The researchers examined routinely collected hospital administrative data in England linked with death certificates to include deaths after discharge to investigate whether there is a relation between the day of the week patients undergo elective surgery and postoperative mortality (elective procedures on weekends represent only 4.5% of the overall total in the United Kingdom). The researchers looked at 4,133,346 inpatient admissions for elective surgical procedures that resulted in 27,582 deaths within thirty days of the procedures (the overall thirty-day mortality rate was 6.7 per 1000 elective surgical admissions).
Over the three-year period studied, the number of weekday procedures decreased over the three-year period by 4.5% and the number of weekend procedures over the three-year period decreased by 26.8%. The researchers also found that weekend patients tended to have less co-morbidity, fewer admissions, longer waiting time (on average seven days more), and lower risk surgery than the Monday patients.
Not considering elective surgery on a Friday or a weekend? You should be aware that the researchers found that the overall risk of death within thirty days for patients having elective surgery increased with each day of the week after Monday on which the procedure was performed (the odds ratio increased by a factor of 1.09 per day after Monday).
Prior research regarding English hospital data found a significantly higher risk of death for emergency surgery patients during the weekend when compared to weekday procedures. A recent report by the National Clinical Enquiry into Peri-Operative Deaths found that less than half of high-risk patients who died received acceptable care and that the postoperative care of high risk patients needs improvement. Other research has described the “weekend effect” (patients admitted during weekends were found to suffer worse mortality and length of stay outcomes when compared to weekday admissions).
The weekend effect is not limited to English hospitals: a study of VA medical centers in the United States found increased thirty-day mortality after non-emergency surgery on Fridays versus early weekdays in patients admitted to regular hospital wards. An Australian study found that after-hours and weekend admissions to intensive care units are associated with increased hospital mortality, with the results attributed mainly to patients with planned admissions after elective surgery.
Two possible explanations for the weekend effect are: poorer quality of care during weekends (possibly due to reduced staffing levels or less experienced staff during weekends) and/or patients admitted or operated on during the weekend are sicker than patients admitted on a weekday.
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