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Don’t get surgery at the end of the week: UK hospital weekend death spike

Published time: May 29, 2013 21:04
The front entrance to St. Mary's Hospital, Paddington, London. (AFP Photo / Martin Hathow)

The front entrance to St. Mary's Hospital, Paddington, London. (AFP Photo / Martin Hathow)

Patients undergoing planned operations in NHS hospitals towards the end of the week, increase the risk of death, according to a groundbreaking new study published in the British Medical Journal on Tuesday.

The subject group contained over 4 million participants who underwent different procedures between 2008 and 2011.

Patients who had surgery on a Friday were found to be 44 per cent more likely to die than those who had operations at the beginning on the week – the risk of death increased incrementally as the week progressed.

Weekend death rates were a staggering 82 percent higher than on a Monday. However, the study also noted that number of patients undergoing surgery on weekends was considerably smaller.

“Death rates were lowest for patients having operations on Monday, increasing by around 10 per cent for each subsequent day of the week,” stated the study, called “Day of week of procedure and 30 day mortality for elective surgery: retrospective analysis of hospital episode statistics,” which was undertaken by the School of Public Health at Imperial College London.

Researchers drew conclusions by linking hospital administrative data with death certificates, using records from 163 trusts and records containing basic information such as age, sex, and source of admission, alongside other variables such as area level of socioeconomic deprivation based on the postcode of a patient’s residence.

The study’s authors suggested that the root of the problem may have been have been related to the lower quality of staff working at the weekends combined with a stronger reliance on temporary workers on non-traditional working days.

It said that the first 48 hours following surgery were critical. However, researchers stated that the study monitored the death rates of patients after discharge too, to get a more accurate impression.

Its researchers claimed that previously, no “large nationally representative studies have examined the day of elective procedure while also accounting for deaths after discharge.”

Because the first 48 hours are so vital, 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 postoperative care overlaps with the weekend,” said Dr Paul Aylin, who led the study.

Image from bmj.com

Critics stated that the statistics were of great cause for concern and said discrepancies were ‘unacceptable.’

“The NHS still seems to work 9am to 6pm Monday to Friday when it needs to be responding to the needs of patients and the public,” Katherine Murphy, chief executive of the Patients Association told the Telegraph.

An ongoing investigation is currently examining 14 NHS hospitals with unusually high death rates, to see whether staff shortages were a factor, Professor Sir Bruce Keogh, NHS England medical director, added in the article.

It had been recognized in the study’s introduction that “a substantial number of patients die as a result of unsafe medical practices and care during their admission to hospital.”

However, a thorough examination of the reasons that may have been behind this had never thoroughly been given, and it was thought that surgery carried out at weekends carried higher risks.  

“Some research has proposed reduced staffing levels or less senior and less experienced staff at the weekends as an explanation, and there is evidence to support the staffing hypothesis,”
the study said.

Its findings suggested a potentially much stronger “’weekday’ and ‘weekend’ effect” for elective procedures than is seen in emergency admissions, also finding some similarities depending upon procedure type.

Several “specific high risk procedures,” were monitored and the same trend was found for higher mortality close to the weekend.

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