Objectives To assess the association between mortality and the day of elective surgical procedure.Design Retrospective analysis of national hospital administrative data.Setting All acute and specialist English hospitals carrying out elective surgery over three financial years, from 2008-09 to 2010-11.Participants Patients undergoing elective surgery in English public hospitals.Main outcome measure Death in or out of hospital within 30 days of the procedure.Results There were 27 582 deaths within 30 days after 4 133 346 inpatient admissions for elective operating room procedures (overall crude mortality rate 6.7 per 1000). The number of weekday and weekend procedures decreased over the three years (by 4.5% and 26.8%, respectively). The adjusted odds of death were 44% and 82% higher, respectively, if the procedures were carried out on Friday (odds ratio 1.44, 95% confidence interval 1.39 to 1.50) or a weekend (1.82, 1.71 to 1.94) compared with Monday.Conclusions The study suggests a higher risk of death for patients who have elective surgical procedures carried out later in the working week and at the weekend. IntroductionA substantial number of patients die as a result of unsafe medical practices and care during their admission to hospital.1 Previous research carried out with English hospital data has suggested a significantly higher risk of death if patients are admitted as an emergency at the weekend compared with a weekday. 2 Other papers have described the "weekend effect"-that is, a worse outcome for patients admitted at weekends compared with weekdays in terms of (in and out of hospital) mortality or length of stay in hospital. [3][4][5] Other studies, however, have found no such effect. 6 Most previous work has focused on acute admissions. A study looking at Veteran Affairs' hospitals in the United State found an increased 30 day mortality (deaths in hospital and after discharge) after non-emergency surgery on Fridays versus early weekdays in patients admitted to regular hospital wards (that is, excluding intensive care units). 7 A recent Australian study reported that after hours and weekend admissions to intensive care units are associated with increased hospital mortality, with the results attributed mainly to patients with planned admissions after elective surgery. 8 A recent English study found an increased risk of hospital death in the elective setting for weekend admissions but, critically (like most previous studies), focused on the day of admission, rather than day of procedure and did not include out of hospital deaths, a potential source of bias. 9There are at least two potential explanations for finding worse outcomes in patients in hospital at the weekend. The first is that these differences reflect poorer quality of care at the weekend, and the second is that patients admitted or operated on at the weekend are more severely ill than those admitted during the week. Some research has proposed reduced staffing levels or less senior and less experienced staff at the weekends as an explana...

SummaryObjectives Adverse drug reactions (ADR) are an important cause of morbidity and mortality. We analysed trends in hospital admissions associated with ADRs in English hospitals between 1999 and 2008.

BackgroundThere is a commonly held assumption that early August is an unsafe period to be admitted to hospital in England, as newly qualified doctors start work in NHS hospitals on the first Wednesday of August. We investigate whether in-hospital mortality is higher in the week following the first Wednesday in August than in the previous week.MethodologyA retrospective study in England using administrative hospital admissions data. Two retrospective cohorts of all emergency patients admitted on the last Wednesday in July and the first Wednesday in August for 2000 to 2008, each followed up for one week.Principal FindingsThe odds of death for patients admitted on the first Wednesday in August was 6% higher (OR 1.06, 95% CI 1.00 to 1.15, p = 0.05) after controlling for year, gender, age, socio-economic deprivation and co-morbidity. When subdivided into medical, surgical and neoplasm admissions, medical admissions admitted on the first Wednesday in August had an 8% (OR 1.08, 95% CI 1.01 to 1.16, p = 0.03) higher odds of death. In 2007 and 2008, when the system for junior doctors' job applications changed, patients admitted on Wednesday August 1st had 8% higher adjusted odds of death than those admitted the previous Wednesday, but this was not statistically significant (OR 1.08, 95% CI 0.95 to 1.23, p = 0.24).ConclusionsWe found evidence that patients admitted on the first Wednesday in August have a higher early death rate in English hospitals compared with patients admitted on the previous Wednesday. This was higher for patients admitted with a medical primary diagnosis.

SUMMARY BackgroundClostridium difficile (C. difficile) infection in hospitals in developed countries continues to be a major public health hazard despite increased control measures including review of antibiotic policies and hygiene measures. Patients with colitis are thought to be particularly vulnerable to C. difficile associated diarrhoea (CDAD). Identifying the clinical burden among hospitalised patients admitted with inflammatory bowel disease is an essential first step towards identifying and treating severe C. difficile infection in such individuals.

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