Weekend operations significantly more risky

 

MORTALITY rates assessed in a review of elective surgery were 82 per cent higher in procedures performed over the weekend rather than on a Monday. These are the findings of a new study published by the BMJ.

Researchers at Imperial College London looked at over four million elective procedures conducted in NHS hospitals in England between 2008 and 2011 and found that the mortality rate was lowest for patients having operations on Monday and increased for each subsequent day of the week.

The odds of death were 44 per cent higher for operations on a Friday rather than a Monday and rose to 82 per cent for those performed over the weekend - though the relative number of weekend operations was small and may represent a different mix of patients.

The authors of the study suggest the findings could reflect differences in the quality of care at the weekend. Lead reseacher Dr Paul Aylin of the School of Public Health at Imperial said: "The first 48 hours after an operation are often the most critical period of care for surgery patients. So if the quality of care is lower at the weekend as some previous studies have suggested, we would expect to see higher mortality rates not just for patients operated on at the weekend, but also those who have operations towards the end of the week, whose postoperative care overlaps with the weekend. That is what we found.

"Unlike previous studies, we included both deaths in hospital and deaths after discharge, so this eliminates a potential bias of counting only in-hospital deaths. We tried to account for the possibility that different types of patients might have operations at the end of the week, but our adjustment made little difference. This leaves us with the possibility that the differences in mortality rates are due to poorer quality of care at the weekend, perhaps because of less availability of staff, resources and diagnostic services."

Previous research had found worse outcomes for patients admitted to hospital as an emergency at weekends, but the new study finds a much stronger weekday effect for elective procedures. The researchers also studied death rates for several specific high-risk procedures, including excision of colon/rectum and heart bypass grafting, and found the same trend for higher mortality close to the weekend.

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