TGIF? Not if you’re having surgery

The “weekend effect” is a well-documented reality in healthcare: Patients who receive care on weekends or major holidays are at greater risk of negative outcomes. However, “Little research has comprehensively examined the effects of weekend postoperative care on surgical outcomes,” observed researchers from the University of Toronto, the University of California and the Houston Hospital in Texas.To fill this gap, the researchers conducted a large retrospective cohort study, the results of were recently published in JAMA Network Open. They show that people who underwent surgery on Fridays had a significantly higher risk of complications, readmissions and death than those operated on Mondays.Scientists analyzed data from 429,691 patients who underwent 25 common surgical procedures in Ontario between Dec. 1, 2007, and Dec. 31, 2019. Of these, 199,744 underwent surgery on a Friday or the day before a holiday or vacation, and 229,947 underwent surgery on a Monday or the day after a holiday or vacation.The average age of those operated on was 59, and 63% of them were women. One third of procedures involved orthopedic surgery (34.4%), another third unspecified general surgery (30.1%) and 14% gynecological surgery. Overall, 363,608 (84.6%) were elective operations and 66,083 (15.4%) were urgent.The only characteristics with a standardized difference greater than 10% were surgeon age and number of years in practice. The clinicians who operated on Fridays were slightly younger (47 vs. 48), but above all less experienced (14 vs. 17 years of practice).Key resultsThe study's main objective was to analyze mortality, complications and rehospitalization after 30 days, 90 days and one year.Overall, these events occurred in 8.5% of cases after surgery on a Friday, compared with 8.1% after surgery on a Monday; a relative increase of 5% that is mainly due to an increase in complications and rehospitalizations.Patients operated on a Friday stayed in hospital longer on average: 3.5 days versus 3.3 days for those operated on a Monday.Overall, these events occurred in 8.5% of cases after surgery on a Friday, compared with 8.1% after surgery on a Monday; a relative increase of 5% that is mainly due to an increase in complications and rehospitalizations.Patients operated on a Friday stayed in the hospital longer on average: 3.5 days versus 3.3 days for those operated on a Monday.In the 30 days following surgery, 0.16% of patients undergoing surgery on Fridays died, compared with 0.15% of those operated on Mondays; this corresponds to a 9% increase in mortality.Within 90 days of surgery, 0.38% of patients operated on during a Friday had died, compared with 0.35% of those operated on during a Monday, representing a 10% increase in mortality.One year after the operation, 1.44% of patients operated on during a Friday had died, compared with 1.30% of those operated on during a Monday, a relative difference of 12%.Those who has operations on a Friday also has woese scores on a composite score combining death, complications and the need for rehospitalization, with a 5% increased risk at 30 days and a 6% increased risk one year after surgery.Read: What does a lung transplant thoracic surgeon do all day?While the researchers did not investigate the causes of these discrepancies in detail, they believe their results may be explained by systemic factors. “Downsizing, less availability of experienced specialists, limited access to diagnostic tests and barriers to care coordination probably play a contributory role,” the study read.A previous meta-analysis of 97 studies, published in 2017 in the Journal of Hospital Medicine, concluded that patients admitted to hospital on Saturday or Sunday had a 19% increased risk of mortality compared to those admitted Monday to Friday. “It is important that healthcare systems assess the impact of this phenomenon on their practices to ensure that patients receive excellent care, regardless of the day,” concluded the authors.

TGIF? Not if you’re having surgery

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