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New Study Shows Higher Mortality for Weekend Surgery

Posted on Jun 18, 2013 by Sergio Ulloa ()  | Tags: British Medical Journal, elective surgery, post-operative mortality

Recent research in England has thrown more light on a worrying phenomenon - the fact that your chances of surviving surgery are greatly influenced by exactly when in the week you have  your operation. The investigation, published by the British Medical Journal in May 2013, has made it clear that weekend surgery or elective procedures carried out later in the week carries a higher risk of death than surgeries performed on Mondays, Tuesdays or Wednesdays.

It has been known for some time that there is a significant association between survival rates and the timing of emergency admissions - those admitted at the weekend have higher mortality after surgery. Other studies from the United States and from Australia in recent years have similarly found a higher correlation between the day of the week of admissions for elective surgery and survival rates - particularly regarding weekend admissions.

This latest British study is the first to focus on the day of surgery itself, rather than just the day of admission, and the investigation has drawn the conclusion that for elective surgery carried out on  Friday or over the weekend, mortality rates are between 44 percent (Friday surgery) and 82 percent (weekend) higher than for equivalent interventions on a Monday.

The precise reason for worse health outcomes over a weekend is unknown; however, researchers suspect this is due to a number of factors. Firstly, there is the issue of fewer staff on duty at weekends, and the likelihood that those employees working on Saturday and Sunday are newer to the job and therefore less experienced. Because serious complications typically occur in the 48 hours immediately following a surgery, it stands to reason that patients who have a procedure near the end of the week may find themselves with fewer staff and resources should problems arise that following weekend.

Some research also shows that patients who wait until the weekend to seek emergency care may be more gravely ill that those visiting the hospital during weekdays. What's more, older or frailer patients may be more vulnerable to this so-called "weekend effect," and researchers have called for more analysis into why some patients are receiving worse care at this particular time of the week. More data is needed to understand how staff and care processes differ on various days of the week.

Survey data, later published in the British Medical Journal this May, was drawn from some 4.1 million operations undertaken in English hospitals over three years. During this period, there were some 27,500 deaths occurring in the 30-day period after a surgery. Researchers looked at English hospital administrative records, examining the relationship between death certificates and days of the week on which an elective surgery occurred.

The research sample included high risk procedures (such as excision of colon and/or rectum and coronary artery bypass) as well as low risk procedures (hip replacement, knee replacement, inguinal hernia and varicose vein stripping). For patients undergoing elective surgery, there was found to be a definite "weekend effect" -- those surgeries which took place near the end of the week or on the weekend resulted in poorer outcomes for the patients.

This study echoes the results of a report by the National Clinical Enquiry into Peri-Operative Deaths, which concluded that less than 50 percent of high risk patients who died experienced  care to a suitable standard, and recommended that the care of such patients be improved.

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