Surgery Outcome Rates Deteriorate on Weekends

A new study has found that the 30-day mortality rates following elective surgery were higher when the procedure was carried out on Friday or over the weekend.

Researchers at Imperial College London (United Kingdom) conducted a retrospective analysis of UK national hospital administrative data at all acute and specialist English hospitals carrying out elective surgery over three financial years, from 2008-09 to 2010-11, to assess the association between mortality and the day of elective surgical procedure. The main outcome measure was death in or out of hospital within 30 days of the procedure. In all, there were 27,582 deaths following 4,133,346 elective inpatient admissions.

The results showed that compared with Monday procedures, elective surgery on a Friday was associated with a 44% increased odds of 30-day mortality. On a weekend, elective surgery had increased odds of 30-day mortality of 82%. Esophageal and/or stomach excision had the highest rate of 30-day mortality, at 35.8 per 1,000 admissions, while the combined group of low-risk surgical procedures, such as hip replacement, had the lowest rate of 30-day mortality, at 2 per 1,000 admissions. The study was published early online on May 28, 2013, in BMJ.

“The first 48 hours following a procedure is most critical and when things can go wrong, such as bleeding and infections. If you don't have the right staff, this is likely to contribute to things being missed,” said lead author Paul Aylin, MD, FFPH. “If I were a patient I would take comfort from the fact the overall death rate is low, but if I were to have an operation towards the end of the week I would be interested in whether the hospital had the appropriate services to look after me throughout my recovery, including at the weekend.”

The researchers say the findings may be due to a poorer quality of aftercare at the weekend, when people who have their surgery later in the week need it most. Factors influencing the poorer quality of care could be due to fewer doctors, nurses, and many nonclinical staff not being available on Saturdays and Sundays.

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