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Decline in ‘weekend effect’ for emergency general surgery patients

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The impact of the so-called “weekend effect” on mortality rates among patients undergoing emergency general surgery appears to have declined over the last decade, according to researchers.

They noted that previous studies had suggested that, in general, patients admitted to hospital on Saturdays or Sundays were more likely to die than those admitted on week days.

“We could no longer detect a statistical difference in outcomes”

Paul O’Loughlin

This so-called “weekend effect” subsequently became the basis for the government’s controversial flagship policy of creating a “seven-day” NHS, ultimately leading to the dispute with junior doctors.

The new study assessed whether such an effect existed in a specified patient population, namely those undergoing emergency general surgery.

The researchers, from the Queen Elizabeth Hospital in Gateshead, looked at mortality data for emergency general surgical admissions in the North of England between 2000 and 2014.

Over the period, they found there were 12,100 in-hospital deaths within 30 days of admission – representing 3.3%.

They said the overall 30-day mortality rate reduced significantly by 46% over the 15-year period studied – from 5.4% in 2000-04 to 4% in 2005-09 and 2.9% during 2010-14.

When they looked at day of admission, they found there was no significant mortality difference for patients admitted at the weekend.

In contrast, there was a significantly higher mortality for operations undertaken at the weekend.

However, the increased mortality that was evident for emergency surgery at the weekend compared with weekdays in 2000-04 had reduced by 2010-14.

Over the 15 years of the study, differences in weekend mortality were most pronounced in the earlier time periods and no longer present in the most recent years, said the researchers.

Queen Elizabeth Hospital

Decline in ‘weekend effect’ in emergency surgery patients

Paul O’Loughlin

Senior study author Mr Paul O’Loughlin said: “Emergency surgery has long been recognised as an area of surgical practice that is high risk, complex and facing significant challenges with an ageing population.

“In conducting this research, we found that there have been great improvements in outcomes overall, and also differences in care provided within the week and at the weekend,” he said in the British Journal of Surgery article.

“In the most recent time period studied we could no longer detect a statistical difference in outcomes on patients operated on at the weekend or during the week,” he added.

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