Risk of Death Not Affected by Weekend Surgery

A new study challenges the paradigm that patients who undergo elective surgery at the end of the week are at a greater risk of dying.

Researchers at the University of Edinburgh, the Royal Infirmary of Edinburgh, and other institutions conducted an observational study of all patients undergoing emergency general surgery in Scotland from January 2005 to December 2007, and who were followed to 2012, in order to assess the effect of day of the week on surgery results. The primary outcome was perioperative mortality, with the secondary outcome being overall survival.

A total of 50,844 patients were identified, 31,499 of who underwent an emergency procedure on Monday to Thursday and 19,345 on Friday to Sunday. Patients undergoing surgery at the weekend were younger and were more likely to have been operated on sooner than those who had weekday surgery. No difference in perioperative mortality or overall survival was observed in surgeries performed over the weekend, despite the fact that patients underwent riskier and/or more complex procedures. The study was published on March 21, 2017, in the British Journal of Surgery.

“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,” said lead author Michael Gillies, MD, of the University of Edinburgh department of anaesthesia, critical care, and pain medicine. “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.”

The so-called “weekend effect” on patient outcomes has been well documented in cases of heart attack, stroke, aneurism, and head trauma in many countries. Reasons for the effect are diverse, and include fewer experienced doctors and nurses working on weekends, reduced diagnostic and interventional services, and patients with less severe conditions delaying treatment.