The following news story appeared in Essentially MIDIRS, vol 4, no 7, July 2013, p24.
A new study, published online in the BMJ (Aylin et al 2013) shows that people having elective surgery on Fridays have a 44% increase in the risk of death in the following 30 days than those undergoing procedures at the beginning of the week, and the risk rises to 82% for those who undergo surgery on Saturday or Sunday.
The authors included data for all elective surgery, which would include elective caesareans, although they focused on higher risk procedures. They considered data separately for each weekday, finding an increase on each day, but considered the weekend as a whole because so few elective operations are carried out at this time.
It is not certain what caused such wide anomalies, although it should be noted with regard to the figures for the weekend that only about 4.5% of elective procedures are carried out at this time so the low numbers involved are likely to have contributed to the high percentage. Although the study looked at data for 30 days following operations, it also produced figures for mortality within two days of surgery as the 48 hours following procedures are considered to be crucial because the risk of bleeding and infection is higher. Mortality within this time was found to be 42% higher for those who underwent an operation on a Friday than on Monday and 167% higher if it was carried out at the weekend. The authors suggest that this increase may be because there are fewer, or less experienced, staff at the weekend to care for postoperative patients.
Another possible explanation is that there is a different case-mix of those scheduled later in the week that carries a higher risk than those earlier in the week. It should be noted that the overall risk of death following elective surgery is actually quite small, but obviously the differences are of concern and it is essential that the underlying cause is identified. Tony Falconer, President of the Royal College of Obstetricians and Gynaecologists said:
“Women should have access to high quality healthcare on the NHS at any time of the day and night, across all days of the week.
We are currently looking at ways to have more senior presence in the labour ward during the out-of-hours period so that we maintain safe, high quality O&G services throughout the week.”