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Weekend surgery has no impact on mortality risk, concludes Scottish study

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The day of the week does not affect the survival chances of people undergoing emergency surgery, according to latest UK research, contrary to theories of the “weekend effect”.

The new findings challenge the results of previous studies, which had suggested that patients who undergo elective surgery on Saturdays and Sundays were at a greater risk of dying.

Analysts had suggested that restricted access to expertise and resources at the weekend – particularly senior staff – were key factors.

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

For the new study, researchers looked at more than 50,000 emergency surgery cases in Scotland over a three-year period between 2005 and 2007.

They tracked patient outcomes until 2012 and found that, after adjustment for other risk factors, the day that a patient underwent surgery had no effect on their short or long-term survival.

Patients who had surgery over the weekend were more likely to have been operated on sooner, the study found, with the average time from admission to operation 1.2 days versus 1.6 for weekdays.

“There was no difference in overall survival after surgery undertaken on any particular day”

Study authors

They were also slightly younger than weekday patients – with an average age of 45.9 compared to 47.5 years – and had fewer co-morbidities, but underwent riskier or more complex procedures.

More than a third of UK procedures are classified as emergencies, said the study authors, who noted emergencies were eight times more likely to die than electives due to the higher complication risk.

However, the Scottish researchers found no evidence to link day of the week to an increased risk of death for those undergoing emergency operations.

They acknowledged that their study involved a smaller number of cases than previous research, but said their work was the first to report analysis of a complete national dataset.

The study, published in the British Journal of Surgery, was funded by Scotland’s Chief Scientist Office.

“There was no difference in overall survival after surgery undertaken on any particular day compared with Wednesday; a borderline reduction in perioperative mortality was seen on Tuesday,” stated the study authors.

Lead author Dr Michael Gillies, a consultant and associate medical director at Edinburgh University, said: “Emergency surgery is associated with far greater risks than elective surgery, so it is reassuring to find that patients in Scotland are receiving the same high standards of care throughout the week.”

As reported by Nursing Times last year, another recent study suggested the impact of the “weekend effect” on mortality rates for emergency general surgery had declined over the last decade.

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.

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