NHS surgery: death risk rises through the week

WEDNESDAY 29 MAY 2013

Having an elective operation? Make sure it is on a Monday, says a new study published in the BMJ, which found that patients are more likely to die in operations conducted at the end of a week.

Death rates for elective surgery patients are lowest on Mondays and increase for each subsequent day of the week, said researchers.

The odds of death after a planned operation in the UK are still very low. But they are 44 per cent higher for patients who had their procedure on a Friday than on a Monday, the study by Imperial College London researchers found.

The landmark study of more than four million elective procedures conducted in NHS hospitals in England between 2008 and 2011, found that the risk of dying got steadily worse as the week went on.

Differences in mortality rates [could be] due to poorer quality of care at the weekend, perhaps because of less availability of staff, resources- Dr Paul Aylin, lead study author

It became higher still if the operation was carried out at the weekend, however only a small number of operations are scheduled to take place on Saturday and Sunday, and this represent a different type of patient.

Elective procedures are surgical operations to correct a condition that is not life-threatening, such as hip or knee replacements, and are scheduled in advance.

The report's authors looked at data concerning patients who had to stay in hospital overnight following their operation. They found that 27,500 patients died within 30 days of their surgery.

Post-op care

The findings could reflect differences in quality of care at the weekend, the authors said.

"The first 48 hours after an operation are often the most critical period of care for surgery patients," said lead author Dr Paul Aylin, from the school of public health at Imperial University.

"So if the quality of care is lower at the weekend as some previous studies have suggested, we would expect to see higher mortality rates not just for patients operated on at the weekend, but also those who have operations towards the end of the week, whose post-operative care overlaps with the weekend. That is what we found.

"Unlike previous studies, we included both deaths in hospital and deaths after discharge, so this eliminates a potential bias of counting only in-hospital deaths. We tried to account for the possibility that different types of patients might have operations at the end of the week, but our adjustment made little difference.

"This leaves us with the possibility that the differences in mortality rates are due to poorer quality of care at the weekend, perhaps because of less availability of staff, resources and diagnostic services."

In an accompanying editorial, Canadian experts question whether officials should rethink the scheduling of elective surgery at the weekend.

They wrote: "Although emergency procedures, such as the repair of ruptured aortic aneurysms, cannot be controlled, the scheduling of elective procedures, such as knee replacements, is wholly within our control.

"If weekend care proves to deliver poorer outcomes than its weekday counterpart, it might be argued that elective procedures should not be scheduled at weekends at all."