May 29, 2013
Study Shows Surgery Deaths Much More Common On Weekends
Brett Smith for redOrbit.com - Your Universe Online
Are all the best doctors out on the golf course during the weekend, leaving some major surgeries to their less experienced colleagues?
According to a new study in the British Medical Journal, patients who have elective surgery on the weekend are 82 percent more likely to die than if they had undergone the procedure on a Monday.
"The first 48 hours after an operation are often the most critical period of care for surgery patients," said lead author Dr. Paul Aylin, from the School of Public Health at the Imperial College London.
The latest study adds to a growing body of evidence about the so-called “weekend effect” which suggests a notably higher risk of death if a person is admitted to the emergency room on the weekend compared with a weekday.
"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,” Aylin said. “That is what we found.”
Using hospital data culled from the UK´s National Health System (NHS) along with British death certificates, researchers investigated information on elective surgery patients' age, gender, source of admission and diagnoses. They defined mortality outcome as any death occurring within 30 days of the procedure.
The study included over 4.1 million elective procedures and almost 28,000 deaths that resulted from those operations between 2008 and 2009 and 2010 to 2011. Weekend patients were found to have fewer diseases, fewer admissions, longer waiting times and lower-risk surgeries.
The team found that the risk of death following a surgical procedure increased each day of the week starting from Monday and culminating with a 44 percent increase in risk for operations that took place on a Friday.
"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,” Aylin said. “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."
The study´s findings also imply that the weekend effect may be more severe for patients with more diseases or more previous admissions than for relatively healthy patients.
In their conclusion, the authors noted that further study needs to be conducted on surgical care processes and organization of staffing to determine if the risks can be entirely attributed to quality of care differences.
In an accompanying editorial in the same journal, doctors from the Mount Sinai Hospital in Toronto asserted that the weekend effect is not due to lower staffing levels, but admit that the study´s results beg further investigation, asking if there are any differences between "surgeons who operate or the surgical teams who work at weekends and those who work in the week.”