There is no ‘weekend effect’ in elective orthopaedic surgery

Abstract

Introduction The 'weekend effect' is said to occur when patient outcomes are adversely affected by the day of the week on which they present to hospital or have surgery. However, it is uncertain whether such a phenomenon exists for elective orthopaedic surgery. We investigated whether there is a 'weekend effect' in elective orthopaedic patients. Methods Retrospectively collected data were obtained from our institution's electronic patient records. We collected demographic and International Statistical Classification of Diseases and Related Health Problems tenth revision coding data for all included patients. Multivariate analyses identified covariate-adjusted risk factors, associated with prolonged stays. Thirty-day mortality data were assessed according to the day on which surgery occurred. Results We analysed data for 892 patients over a one-year period. During the year, 457 patients had a total hip and 435 had a total knee replacement; 814 patients (91.3%) underwent surgery during the week, while 78 (8.7%) had surgery on a Saturday. There was no difference in average length of stay between the groups (5.0, 2.6 vs 5.0, 3.4, P = 0.95). Variables associated with prolonged hospitalisation included increasing age (covariate adjusted relative risk 1.02, 95% confidence interval 1.01-1.03, P < 0.001) and an American Society of Anesthesiologists score of 2, (relative risk 1.6, 95% confidence interval 1.15-2.20, P = 0.005). There was one death in a patient who underwent surgery on a Monday. Conclusions There is no 'weekend effect' for elective orthopaedic surgery.

Assessing the Influence of Attending Surgeon Continuity on Free Flap Outcomes Following Unplanned Returns to the Operating Room

“…10 The most common cause of flap loss in our study was venous thrombosis, a finding which has been previously reported. 21,22 Interestingly, however, we did not find that surgeon experience (> 5 years) was a determinant of flap failure or success following the take-back operation. 9 In this study, we evaluated all etiologies of unplanned returns to the OR for up to 30 postoperative days.…”

“…However, this finding was not supported in the orthopedic literature where no differences in surgical outcomes were demonstrated when comparing elective cases performed during the week versus on the weekend. 21 A potential reason for our finding of increased rates of flap loss on the weekend may extend beyond the surgeon but may also involve the surgical staff. Doll et al established a possible association between surgical scrub technician handoffs and postoperative complications.…”

Weekend versus Weekday Procedures for Total Hip Arthroplasties

“…27 However, our findings contrast with various studies in the United Kingdom that found no weekend effect for elective THA and TKA procedures on mortality and LOS. 16,18,19 This potentially highlights the discrepancy between the two health care structures, as there are clear differences in insurance, payment, and staffing that can all affect how much weekend workflow differs from that on weekdays. 35 This difference in day-of-surgery effects on LOS between U.S. and U.K. studies suggests that the cause may stem from a difference in hospital staffing and structure on weekends.…”

“…13,14 This ambiguity is further evident as various studies exhibit no significant differences in 30-day mortality after elective surgeries or hip fracture operations conducted on weekdays versus weekends and no association between surgery day of the week and LOS after elective lower limb arthroplasties. [15][16][17][18] Few studies have even shown that elective joint arthroplasty procedures performed on the weekday have increased postoperative mortality compared to operations performed on the weekend, warranting further evaluation of outcomes in elective orthopaedic surgeries. 19 The exact mechanism behind the "weekend effect" is unclear.…”

Trends in Pediatric Orthopaedic Publications by Language

“…Many studies have focused on understanding trends in the most cited publications in various orthopaedic fields. [3][4][5][6][7][8] With 98% of all scientific studies published being written in English, these studies found that the most cited articles in orthopaedics are also written in English. 1 Some journals and conferences will only publish and present works in English.…”