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Death rates after surgery higher at end of week

Patients who have elective surgery later in the week and at the weekend have a greater risk of dying, new research suggests.

Previous studies have found there to be a significantly higher risk of death if patients are admitted as an emergency over the weekend compared with a weekday, but this is the first national study into elective surgery to report a “weekday effect”.

Researchers from Imperial College London examined death rates for planned admissions by day of the week of procedure.

National hospital administrative data on the age, gender, source admission and diagnosis of patients was linked with death certificates. Mortality outcome was defined as any death occurring within 30 days and two days of the index procedure.

The research, published on bmj.com, examined all operating room procedures for elective inpatient admissions for three years. It also focused on a selection of low and high-risk surgical procedure groups.

The findings showed there were 4,133,346 elective inpatient surgical procedures during 2008-09 to 2010-11, with 27,582 deaths occurring within 30 days of the date of procedure. A total of 4.5% of this surgery was performed at the weekend.

Weekend patients tended to have fewer diseases, fewer admissions, longer waiting times and low-risk surgery.

The overall risk of death for patients undergoing elective surgery increased with each day of the week, by an odds ratio factor of 1.09 per day from Monday. Compared with Monday, the risk of dying was significantly higher if procedures were carried out on a Friday.

The results of the research suggest that the weekend effect might be more pronounced for patients with more diseases and for patients with three or more previous admissions than for patients with none.

 

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