Weekend Surgical Care and Postoperative Mortality

Smith, Stephen R.; Yamamoto, Jennifer M.; Roberts, Derek J.; Tang, Karen; Ronksley, Paul E.; Dixon, Elijah; Buie, W. Donald; James, Matthew T.

doi:10.1097/mlr.0000000000000860

Cited by 59 publications

(25 citation statements)

References 44 publications

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“…We did not find significant differences in the mortality of patients who underwent ETI in the daytime and off-hours. A previous study indicated that admission on the weekend was associated with a significantly increased mortality compared with that of a midweek admission [ 2 , 17 , 18 ] . Various factors have been attributed to the difference between mortality in daytime and off-hours, such as the availability of senior specialists, the number of skilled nursing staff, and human factors, such as sleep deprivation and fatigue [ 19 , 20 ] .…”

Section: Discussionmentioning

confidence: 99%

Emergency tracheal intubation during off-hours is not associated with increased mortality in hospitalized patients: a retrospective cohort study

Liu

Jin²,

Lai

et al. 2020

BMC Anesthesiol

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Background The prognosis of hospitalized patients after emergent endotracheal intubation (ETI) remains poor. Our aim was to evaluate the 30-d hospitalization mortality of subjects undergoing ETI during daytime or off-hours and to analyze the possible risk factors affecting mortality. Methods A single-center retrospective study was performed at a university teaching facility from January 2015 to December 2018. All adult inpatients who received ETI in the general ward were included. Information on patient demographics, vital signs, ICU (Intensive care unit) admission, intubation time (daytime or off-hours), the department in which ETI was performed (surgical ward or medical ward), intubation reasons, and 30-d hospitalization mortality after ETI were obtained from a database. Results Over a four-year period, 558 subjects were analyzed. There were more male than female in both groups (115 [70.1%] vs 275 [69.8%]; P = 0.939). A total of 394 (70.6%) patients received ETI during off-hours. The patients who received ETI during the daytime were older than those who received ETI during off-hours (64.95 ± 17.54 vs 61.55 ± 17.49; P = 0.037). The BMI of patients who received ETI during the daytime was also higher than that of patients who received ETI during off-hours (23.08 ± 3.38 vs 21.97 ± 3.25; P < 0.001). The 30-d mortality after ETI was 66.8% (373), which included 68.0% (268) during off-hours and 64.0% (105) during the daytime (P = 0.361). Multivariate Cox regression analysis found that the significant factors for the risk of death within 30 days included ICU admission (HR 0.312, 0.176–0.554) and the department in which ETI was performed (HR 0.401, 0.247–0.653). Conclusions The 30-d hospitalization mortality after ETI was 66.8%, and off-hours presentation was not significantly associated with mortality. ICU admission and ETI performed in the surgical ward were significant factors for decreasing the risk of death within 30 days. Trial registration This trial was retrospectively registered with the registration number of ChiCTR2000038549.

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Section: Discussionmentioning

confidence: 99%

Emergency tracheal intubation during off-hours is not associated with increased mortality in hospitalized patients: a retrospective cohort study

Liu

Jin²,

Lai

et al. 2020

BMC Anesthesiol

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“…Healthcare interventions on weekends have been associated with increased mortality and adverse clinical outcomes [1–11], but these findings are inconsistent [12–15]. The overall interpretation of studies of different populations, healthcare systems, and procedures has generated much controversy and debate regarding the possibility of a “weekend effect” impacting the quality of healthcare [10,16].…”

Section: Introductionmentioning

confidence: 99%

Hospital admission on weekends for patients who have surgery and 30-day mortality in Ontario, Canada: A matched cohort study

et al. 2019

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BackgroundHealthcare interventions on weekends have been associated with increased mortality and adverse clinical outcomes, but these findings are inconsistent. We hypothesized that patients admitted to hospital on weekends who have surgery have an increased risk of death compared with patients who are admitted and have surgery on weekdays.Methods and findingsThis matched cohort study included 318,202 adult patients from Ontario health administrative and demographic databases, admitted to acute care hospitals from 1 January 2005 to 31 December 2015. A total of 159,101 patients who were admitted on weekends and underwent noncardiac surgery were classified by day of surgery (weekend versus weekday) and matched 1:1 to patients who both were admitted and had surgery on a weekday (Tuesday to Thursday); matching was based on age (in years), anesthesia basic unit value for the surgical procedure, median neighborhood household income quintile, resource utilization band (a ranking system of overall morbidity), rurality of home location, year of admission, and urgency of admission. Of weekend admissions, 16.2% (25,872) were elective and 53.9% (85,744) had surgery on the weekend of admission. The primary outcome was all-cause mortality within 30 days of the date of hospital admission. The 30-day all-cause mortality for patients admitted on weekends who had noncardiac surgery was 2.6% (4,211/159,101) versus 2.5% (3,901/159,101) for those who were admitted and had surgery on weekdays (adjusted odds ratio [OR] 1.05; 95% CI 1.00 to 1.11; P = 0.03). However, there was significant heterogeneity in the increased odds of death according to the urgency of admission and when surgery was performed (weekend versus weekday). For urgent admissions on weekends (n = 133,229), there was no significant increase in odds of mortality when surgery was performed on the weekend (adjusted OR 1.02; 95% CI 0.95 to 1.09; P = 0.7) or on a subsequent weekday (adjusted OR 1.05; 95% CI 0.98 to 1.12; P = 0.2) compared to urgent admissions on weekdays. Elective admissions on weekends (n = 25,782) had increased risk of death both when surgery was performed on the weekend (adjusted OR 3.30; 95% CI 1.98 to 5.49; P < 0.001) and when surgery was performed on a subsequent weekday (adjusted OR 2.70; 95% CI 1.81 to 4.03; P < 0.001). The main limitations of this study were the lack of data regarding reason for admission and cause of increased time interval from admission to surgery for some cases, the small number of deaths in some subgroups (i.e., elective surgery), and the possibility of residual unmeasured confounding from increased illness severity for weekend admissions.ConclusionsWhen patients have surgery during their hospitalization, admission on weekends in Ontario, Canada, was associated with a small but significant proportional increase in 30-day all-cause mortality, but there was significant heterogeneity in outcomes depending on the urgency of admission and when surgery was performed. An increased risk of death was found only for elective admissions on ...

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“…In a recent systematic review and meta-analysis, which is by far the best methodological tool, the odds ratio for postoperative mortality increased from Monday to Friday. 8 If it were true that postoperative complication rates are higher when elective surgery is on a Friday, compared with operations performed earlier in the week, this would have important implications for informed consent and public health. Our results revealed no association between the day of the week when the surgery took place and morbidity.…”

Section: Discussionmentioning

confidence: 99%

The Weekday Effect on Morbidity of Lung Cancer Surgery: A Real-World Analysis

Bertolaccini

Prisciandaro

Iacono

et al. 2021

Thorac Cardiovasc Surg

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Background Many authors have investigated the possible adverse effects among patients who underwent elective surgery on Friday when compared with patients operated earlier in the week. Nonetheless, the weekday effect is still a matter of debate. This study aimed at investigating the postoperative morbidity rates after lung cancer surgery and their relationship with the weekday the surgery took place. Materials and Methods We retrospectively reviewed the clinical records of patients who underwent elective thoracotomic lobectomies for lung cancer. Categorical data were analyzed using the chi-square test or Fisher's exact test. Association between predictors and binary outcomes while considering the weekday stratification was determined with Cochran–Mantel–Haenszel statistics. To characterize the typical Friday patient, a multiple logistic regression analysis was performed. Results A total of 817 patients (2015–2019) were identified. Complication rates divided by day of surgery were 164 (20.07%) for patients operated on Mondays, 182 (22.27%) on Tuesdays, 205 (25.09%) on Wednesdays, 172 (21.05%) on Thursdays, and 94 (11.51%) on Fridays. Crude morbidity rates by weekday were Monday 21.53%, Tuesday 20.51%, Wednesday 27.70%, Thursday 20.0%, and Friday 10.26%. No overall association between day of surgery and overall morbidity was found (ρ = 0.095). Median hospital length of stay was 5 days (range: 2–45 days), and there were no statistically significant differences between days. The Cochran–Mantel–Haenszel statistics showed no association between morbidity and the weekday. Conclusion In patients undergoing elective lobectomies for lung cancer, the weekday of surgery was not statistically significantly associated with an increase in the risk of postoperative morbidity.

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Weekend Surgical Care and Postoperative Mortality

Abstract: Supplemental Digital Content is available in the text.

Cited by 59 publications

References 44 publications

Emergency tracheal intubation during off-hours is not associated with increased mortality in hospitalized patients: a retrospective cohort study

Emergency tracheal intubation during off-hours is not associated with increased mortality in hospitalized patients: a retrospective cohort study

Hospital admission on weekends for patients who have surgery and 30-day mortality in Ontario, Canada: A matched cohort study

The Weekday Effect on Morbidity of Lung Cancer Surgery: A Real-World Analysis

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