A new study notes a much higher risk of death associated with surgery performed at the end of the week, compared with Monday surgeries.
WEEKEND SURGERY IS MORE RISKY THAN WEEKDAY SURGERY
Previous studies have suggested that surgeries performed after hours and on the weekends are associated with a greater risk of death when compared to surgeries performed earlier in the week. This finding is not particularly surprising, as patients who undergo surgery after hours and on weekends are more likely to be undergoing surgery for emergency conditions, and are likely to be more severely ill, compared with patients who are undergoing elective scheduled surgery on weekdays. However, a newly published research study shows that elective non-emergency surgeries are also associated with a much greater risk of death when performed at the end of the week or on weekends, when compared with elective surgeries performed early in the week. This clinical research study appears in the current issue of the British Medical Journal.
A retrospective study reviewed hospital data between 2008 and 2010 for all public hospitals in England. In particular, the outcomes of patients undergoing elective surgery were analyzed. Altogether, 4,133,346 inpatient admissions for elective surgery were evaluated. These more than 4 million surgical cases were associated with 27,582 deaths within 30 days of surgery.
When compared to elective surgeries performed on Mondays, elective non-emergency surgeries performed on Fridays were associated with a 44 percent increase in the risk of death. The news for elective surgeries conducted over the weekend was even worse. Compared to Monday surgeries, elective surgeries conducted over the weekend were associated with an 82 percent increase in the risk of death!
English public hospitals, like most hospitals in the United States, sharply reduce their staffing levels on weekends. Given that life-threatening complications associated with major operations are most likely to occur during the first 72 hours following surgery, it is not surprising that major operations performed on Fridays or weekends, even elective non-emergency operations, are associated with a higher risk of complications and death, as the patient safety benefit associated with full weekday staffing in the hospital is lost on weekends (and holidays) in the vast majority of hospitals. In my own Surgical Oncology practice, I routinely schedule major elective surgeries at the beginning of the week, in recognition of what has been called the “weekend effect.” I and my Surgical Oncology colleague also personally see all of our surgical patients seven days a week, including weekends and holidays, in an effort to ensure that their ongoing care meets the highest standards, and to closely follow their postoperative recoveries.
Unfortunately, not all complications, and not all deaths, can be prevented following surgery. However, data from clinical research studies such as this study provide important opportunities to reduce postoperative complications, including the “ultimate complication,” to the lowest achievable levels.
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According to recent Bureau of Labor Statistics, the unemployment rate for veterans who served on active duty between September 2001 and December 2011 is more than 12 percent. A new website, Veterans in Healthcare, seeks to connect veterans with potential employers. If you are a veteran who works in the healthcare field, or if you are an employer who is looking for physicians, advanced practice professionals, nurses, corpsmen/medics, or other healthcare professionals, then please take a look at Veterans in Healthcare. As a retired veteran of the U.S. Army, I would also like to personally urge you to hire a veteran whenever possible.
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Dr. Wascher is an oncologic surgeon, professor of surgery, cancer researcher, oncology consultant, and a widely published author
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