Beware of the weekend effect

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When given the choice of when to have an elective surgery, you may be better off choosing a time earlier in the week, especially as opposed to over the weekend. According to a new study published online in BMJ, opting for surgery on a Friday or over a weekend results in increased rates of 30-day mortality.

Researchers from Imperial College in London analyzed about 4 million elective inpatient admissions which resulted in 28,000 deaths. After looking at rates of death 30 days after the procedures, they found that having surgery on a Friday was associated with a 44 percent increased risk of mortality and having surgery on a weekend was linked with an 82 percent increased risk of mortality. Mortality risk increased by 9 percent each day after Monday. The highest rates of mortality were seen in esophageal and/or stomach excisions and the lowest rates were seen in low-risk surgeries which included hip replacement, knee replacement, inguinal hernia, varicose vein stripping and tonsillectomy.

Drs. Janice Kwan and Chaim Bell of the University of Toronto, in an editorial, note that, If weekend care proves to deliver poorer outcomes than its weekday counterpart, it might be argued that elective procedures should not be scheduled at weekends at all. Future research should better elucidate which elective procedures follow the weekend effect and which do not, as well as which patients, surgeons, and surgical teams are best suited for elective procedures at the weekend.

ACSH s Dr. Gilbert Ross reminisced thusly: When I was in training back in the last century, we always had the impression that new hospital admissions during the weekend, as with early July admissions (when house staff residents were brand new on the job), were fraught with peril. This applied to both medical and surgical cases. So this study is unsurprising to me, but should put both doctors and patients on the alert: try not to schedule elective procedures on the weekends, and if you do, be especially alert for misadventures.