Operation death rates higher at the end of the week and at weekend

Operation death rates higher at the end of the week and at weekend

A higher death risk for patents who have elective surgery later in the week and on weekends has been found, compared with those earlier in the week, according to new research published in BMJ.

Earlier studies have suggested a notably higher risk of death if admitted as an emergency patient during the weekend compared with weekdays. Additionally, other research has detailed the "weekend effect."

The current study, the first to concentrate on day of elective surgery to report a "weekday effect" examined death rates for planned admissions by day of the week of procedure. The researchers, from Imperial College London, hypothesized that if there is a quality of care issue at weekends, higher death rates would be seen for procedures conducted towards the end of the week and during the weekends.

The study used national hospital administrative data and their linked death certificates. Information regarding patients' diagnosis, source admission, age, and gender were also used.

Mortality outcome was described as any death that occurred within 30 days of the index procedure.

The team analyzed all operating room procedures for planned inpatient admissions for three years. Additionally, they concentrated on a variety of low and high risk surgical procedure groups.

Among them were 4,133,346 elective inpatient surgical procedures with 27,582 deaths within 30 days of the procedure date during 2008/9 to 2010/11. Of this surgery, 4.5% were completed during the weekend.

Weekend patients showed:

  • a lower incidence of disease
  • fewer admissions
  • longer waiting time
  • low-risk surgery
The overall risk of 30-day death for patients having elective surgery rose with each day of the week the procedure was performed ( by 1.09 odds ratio factor per day from Monday). Compared with Monday, the risk of death was notably greater if procedures were done on a Friday.

Also there were significant variances in the rates of death for each day of the week, compared with Monday, for all procedures.

The 30-day mortality rates for the five major surgical procedures per 1000 admissions included:

  • 35 for excision of esophagus and/or stomach
  • 24 for excision of colon and/or rectum
  • 20 for excision of lung
  • 20 for coronary artery bypass graft
  • 34 for repair of abdominal aortic aneurysm
All procedures besides abdominal aortic aneurysm repair, had statistically relevant trends towards higher mortality at the end of the week and weekends compared with Monday.

These results imply that the weekend effect could be more obvious for patients with more diseases and for patients with three or more earlier admissions, than for patients with none.

The authors conclude that additional information is required on surgical care processes in order to determine if the possible risk can be totally attributed to variances in quality of care. Also, plans need to be made for efficient services to support these patents and guarantee the best outcome.

A separate study conducted by the University of Pennsylvania School of Medicine suggested it is possible to negate the outcomes of the "weekend effect". They revealed that patients who have been inured in car or bike crashes, been shot or stabbed, or suffered other injuries are more likely to live if they arrive at the hospital on the weekend than during the week.

Editorial Comments

Doctors Janice L Kwan and Chaim M Bell, from Mount Sinai Hospital, Toronto, Canada, wrote in an accompanying editorial that the "weekend effect" is not a result of lower staffing levels. However, the study's findings do beg the question "What makes weekend patients different?"

The authors question whether there might be any differences between "surgeons who operate or the surgical teams who work at weekends and those who work in the week".

It is possible to schedule elective procedures, but are we willing to "sacrifice the safe provision of care for shorter procedural wait times and length of stay", they wonder.

Death Rate for Surgery Patients Higher on the Weekend (Video Medical And Professional 2020).

Section Issues On Medicine: Medical practice