JAMA surgery in a new article says people who have surgery performed just before a weekend called the “weekend effect,” on Thursday and Friday had a greater chance of dying, suffering a complication, and more likely to go back to the hospital compared to people with surgeries done after the weekend.
What is the “weekend” effect with surgeries?
Hospitals and healthcare systems have variations in operative and organizational structure or how they work during the transition from weekdays to weekends. The “weekend effect,” refers to the potential for worse patient outcomes during weekends compared to weekdays.
The study looked at 400,000 patients, 47 % with scheduled or planned surgeries or emergency surgery right before the weekend and the other 53% with surgeries right after the weekend. They found a 5 % greater chance of having a bad outcome both in the short- and long-term including death, complications, and readmissions back to the hospital for surgeries done right before the weekend. Emergency surgeries if not “delayed,” over the weekend also had worse outcomes if done on Friday instead of Monday.
A study in BMJ or British Medical Journal further supports the “weekend effect,” reporting 27,000 deaths within 30 days with odds of dying of 44 % higher if the surgery was done on Friday compared with Monday.
Are worse outcomes due to differences in doctors?
Yes, there were differences between the surgeons or doctors operating on people before and after the weekends in the study. They found that surgeons operating on Friday had fewer years of practice experience and younger in age compared to doctors performing surgeries on the weekdays with 14 versus 17 years of practice experience.
The “weekend effect,” did not depend on whether the surgery was complex or simple and seen over a variety of surgeries including orthopedics, brain or neurosurgery, heart or cardiovascular. It also did not depend if the surgery was for the sickest patients with those having emergency surgery on Mondays and Tuesdays faring better than those operated on Thursdays and Fridays.
Also, there are generally fewer cases in the operating room scheduled on Fridays with doctors and staff eager to leave for the weekend which may lead to decreased attention to detail and in fact Friday in a study out of Canada is the day more patients are sent to intensive care units (ICU) than other days.
Anything about hospitals that leads to worse surgical outcomes?
It is likely not just doctors but hospital systems and staffing over the weekends that leads to higher risks of death, complications including blood clots, infections, and longer time spent in the hospital.
In Journal of American Medical Association (JAMA), article showed the “weekend effect,” from a hospital or system is complex and may be due to a number of factors. Contributing factors may be fewer nurses to number of patients or lower nursing ratios meaning each nurse may have more patients to care for than he or she would have on a weekday. This may lead to keeping bladder catheters in too long after surgery, a potential source of infection, and not walking or ambulating patients over the weekend as ambulation after surgery can prevent complications including getting blood clots and staying longer in the hospital.
Another study showed the “weekend effect,” improved in hospitals with higher nursing to patient ratios, weekend robust rehabilitation programs to get patients up and walking, and good pain management programs. Further studies need to be done to validate the results and how to boost hospital resources over weekends which is challenging in the wake of a looming nursing shortage coupled with fewer nurses wanting to work on weekends.
Any advice on when to have a surgical procedure?
Surgeries especially on Friday may not be the best idea. If an emergency little choice but if you are planning elective surgery for example knee replacement even though a Friday may sound appealing as you have a weekend to recover and more flexibility you may want to consider choosing another day of the week if an option.
Things to consider before scheduling a day for the procedure and going under the knife is the experience level of the doctor for your type of surgery as more experienced surgeons have better outcomes and tend to operate on Tuesdays and Wednesdays whereas less experienced on Fridays.
So, advice is if you need to have surgery convenience in terms of day of the week is less important than researching the experience and outcomes of your doctor, scheduling the procedure on whatever day he or she wants, and also if given options shoot for a Tuesday or Wednesday and preferably in the mornings when the operating room staff and doctor is at their very best.
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