Elective surgery deaths occur at a significantly higher rate when surgery is performed on a Friday, Saturday or Sunday. Worse outcomes for patients admitted on weekends compared with weekdays measured by death and length of stay are explained as the “Weekend Effect”. A recent study in the British Medical Journal confirmed the higher risk of death and complications for surgeries done at the end of the week and on weekends. The risk of dying from surgery on Saturday or Sunday was almost double the risk (82% higher) when surgery was performed on Monday. The risk of dying from surgery on a Friday was 44% higher than on a Monday. The elective surgeries that were looked at were colon resection, coronary artery bypass grafting (CABG), repair of abdominal aortic aneurysm, lobectomy or lung resection and a single combined group that included hip replacement, knee replacement, inguinal hernia repair, varicose vein stripping and ligation, tonsillectomy, femoral hernia repair and abdominal wall hernia repair.
One likely reason for the higher number of surgery deaths on Fridays and weekend is that serious complications are most likely to occur in the first 48 hours after an operation. Since the medical staff attending to patients in hospital is smaller on the weekend and often “covering physicians” are rendering the care, it is not surprising that detrimental changes in patients’ conditions are not as readily noticed and acted upon. Furthermore, frailer patients (such as older patients and patients with multiple co-morbidities) are at an even higher risk of dying when surgery is done on the weekend.
Britcher Leone & Roth understands that surgical errors both in the operating room and in the post-surgical period can cause catastrophic injury and death. However, only a careful analysis of the medical record can tell if a bad outcome or death after surgery was caused by error or neglect of a patient’s change in condition.