Outcomes are Worse in US Patients Undergoing Surgery on Weekends Compared With Weekdays

Glance, Laurent G.; Osler, Turner M.; Li, Yue; Lustik, Stewart J.; Eaton, Michael P.; Dutton, Richard P.; Dick, Andrew W.

doi:10.1097/mlr.0000000000000532

Cited by 73 publications

(88 citation statements)

References 24 publications

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“…Acute conditions requiring time critical diagnosis or intervention may be hampered by deficient resources and staffing at weekends 18, 33 . Generic studies may not account for the heterogeneity of emergency provisions across specialities and may explain the equipoise in evidence.…”

Section: Discussionmentioning

confidence: 99%

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Comparing mortality risk of patients with acute hip fractures admitted to a major trauma centre on a weekday or weekend

Nandra

Pullan

Bishop

et al. 2017

Sci Rep

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Proximal femoral fractures are a major public health concern with estimated annual direct and social costs amounting to £2 billion and average 30-day mortality risk of 7.5%. In response to the recent debate over out-of-hours hospital provision we investigated the ‘weekend effect’ at a major trauma centre, caring for acute injuries. A single centre, multi-surgeon review of 2060 patients performed. The distribution of patient and treatment variables compared in patients admitted on a weekday or the weekend. Fewer patients met performance indicators during weekend admission, time to surgery (63 vs. 71%) and time to geriatric review (86 vs. 91%). Weekend admission 30-day mortality was marginally lower than weekday (9.7% vs. 10.2%, OR 0.94, 95% CI 0.67 to 1.32, p = 0.7383). Increasing age, female gender, co-morbidities and confusion increased mortality risk. Binary regression analysis including these variables found no significant ‘weekend effect’. Despite the unit observing an increasing workload in the last five years, with meticulous workforce planning, senior doctor provisions and careful use of resources, it is possible to provide a seven-day fracture neck of femur service with no variation in thirty-day mortality by the day of admission.

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Section: Discussionmentioning

confidence: 99%

“…The policies have imparted an ethos of multi-disciplinary care, early surgery and targeted rehabilitation, with a notable reduction in TDM 14 . However, we do not know whether the day of admission influences patient outcomes and overall survival 18, 19 .…”

Section: Introductionmentioning

confidence: 99%

Comparing mortality risk of patients with acute hip fractures admitted to a major trauma centre on a weekday or weekend

Nandra

Pullan

Bishop

et al. 2017

Sci Rep

View full text Add to dashboard Cite

show abstract

“…A number of relatively small studies, generally of patients having scheduled surgery, have reported inconsistent and inconclusive variation in postoperative mortality between weekdays and the weekend . Similarly, a number of studies have reported inconsistent associations of postoperative mortality with the time of day surgery was started .…”

Section: Introductionmentioning

confidence: 99%

Associations of postoperative mortality with the time of day, week and year

et al. 2018

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Studies that have investigated circadian, weekday and seasonal variation in postoperative mortality have been relatively small or have been for scheduled surgery. We retrospectively tested a large mixed surgical cohort from a German tertiary care university hospital for the presence of cyclical variation in all-cause in-hospital mortality after operations performed between 2006 and 2013. We analysed mortality rates after 247,475 operations, adjusted for age, sex, comorbidities, location, urgency and duration of the surgery, and intra-operative blood transfusions. The mortality odds ratio (95%CI) after operations started in the morning (08:00-11:00) were lowest, 0.73 (0.66-0.80), p < 0.001 and highest for operations started in the afternoon (13:00-17:00), 1.29 (1.18-1.40), p < 0.001. Mortality at the weekend was the same as during the week. There was no seasonal variation in mortality, p = 0.12. However, the interference of four-yearly and ten-monthly cycle amplitudes resulted in higher mortality odds ratio (95%CI) in winter 2008-2009, 1.41 (1.18-1.69), p < 0.001, and lower mortality in spring 2011 and 2012, 0.70 (0.56-0.85) and 0.67 (0.53-0.85), p < 0.001 and p = 0.001, respectively. The ability to predict cyclical phenomena would facilitate the design of interventional studies, aimed at reducing mortality following surgery in the afternoon and when cycles interfere constructively.

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“…First, as compared with weekday teams (of surgeons, anesthesiologists, and nurses), weekend call teams may have less expertize to care for specific surgical problems. 13 On weekends, on-call anesthesiologists and surgeons may respond to surgical procedures not typically covered on weekdays. 13 Second, in comparison with weekdays, attending anesthesiologists may cover more cases and supervise more extenders (nurse anesthetists or residents) on weekends, especially when patients requiring emergency surgery are added to the schedule.…”

Section: Discussionmentioning

confidence: 99%

“…In total, of these three studies, 9,13,14 endovascular aortic repair in the weekend group (18.2%) was performed significantly (p < 0.00001 by χ 2 tests) less than that in the weekday group (30.8%). Although endovascular aortic repair was adjusted for using multivariable analyses in only one 14 of these studies, 9,13,14 the impact of endovascular aortic repair on early mortality was not reported.…”

Section: Sensitivity Analysesmentioning

confidence: 99%

A meta-analysis of weekend admission and surgery for aortic rupture and dissection

2017

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We performed a meta-analysis to determine whether weekend admission and surgery for ruptured abdominal/thoracic aortic aneurysm (RAAA/RTAA) and acute aortic dissection (AAD) is associated with increased mortality. MEDLINE and EMBASE were searched from January 1946 to December 2016 using PubMed and OVID. Eligible studies were prospective or retrospective, comparative or cohort studies enrolling patients admitting or undergoing surgery for RAAA/RTAA/AAD and reporting mortality after weekend (including holiday) versus weekday admission/surgery. Our search identified 11 studies including a total of 166,195 patients. A pooled analysis of 13 adjusted odds ratios (ORs), one adjusted hazard ratio, and one unadjusted OR from all 11 studies demonstrated a statistically significant 32% increase in mortality with weekend admission/surgery (OR, 1.32; 95% confidence interval (CI), 1.20 to 1.45; p < 0.00001). Despite possible publication bias disadvantageous to weekend admission/surgery based on funnel plot asymmetry, adjustment for the asymmetry using the trim-and-fill method did not alter the significant association of weekend admission/surgery with increased mortality (OR, 1.21; 95% CI, 1.09 to 1.34; p = 0.0006). In conclusion, weekend admission/surgery for ruptured abdominal/thoracic aortic aneurysm and acute aortic dissection (AAD) may be associated with increased mortality.

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Outcomes are Worse in US Patients Undergoing Surgery on Weekends Compared With Weekdays

Cited by 73 publications

References 24 publications

Comparing mortality risk of patients with acute hip fractures admitted to a major trauma centre on a weekday or weekend

Comparing mortality risk of patients with acute hip fractures admitted to a major trauma centre on a weekday or weekend

Associations of postoperative mortality with the time of day, week and year

A meta-analysis of weekend admission and surgery for aortic rupture and dissection

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