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...

Background: Serious injuries have been stated as a public health priority in the UK. However, there appears to be a lack of information on population-based rates of serious injury (as defined by a recognised taxonomy of injury severity) at national level from either official statistics or research papers. We aim to address this through a search and review of literature primarily focused within the UK and Europe.

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ObjectivesTo describe functional outcomes, care needs and cost-efficiency of hospital rehabilitation for a UK cohort of inpatients with complex rehabilitation needs arising from inflammatory polyneuropathies.Subjects and Setting186 patients consecutively admitted to specialist neurorehabilitation centres in England with Guillain-Barré Syndrome (n = 118 (63.4%)) or other inflammatory polyneuropathies, including chronic inflammatory demyelinating polyneuropathy (n = 15 (8.1%) or critical illness neuropathy (n = 32 (17.2%)).MethodsCohort analysis of data from the UK Rehabilitation Outcomes Collaborative national clinical dataset. Outcome measures include the UK Functional Assessment Measure, Northwick Park Dependency Score (NPDS) and Care Needs Assessment (NPCNA). Patients were analysed in three groups of dependency based on their admission NPDS score: ‘low’ (NPDS<10), ‘medium’ (NPDS 10–24) and ‘high’ (NPDS ≥25). Cost-efficiency was measured as the time taken to offset the cost of rehabilitation by savings in NPCNA-estimated costs of on-going care in the community.ResultsThe mean rehabilitation length of stay was 72.2 (sd = 66.6) days. Significant differences were seen between the diagnostic groups on admission, but all showed significant improvements between admission and discharge, in both motor and cognitive function (p<0.0001). Patients who were highly dependent on admission had the longest lengths of stay (mean 97.0 (SD 79.0) days), but also showed the greatest reduction in on-going care costs (£1049 per week (SD £994)), so that overall they were the most cost-efficient to treat.ConclusionsPatients with polyneuropathies have both physical and cognitive disabilities that are amenable to change with rehabilitation, resulting in significant reduction in on-going care-costs, especially for highly dependent patients.