The ‘weekend effect’ means a group of 1,000 patients could result in 8 more cases of complications for those treated on a Friday
If you have an upcoming surgery and are able to book the date yourself, a new study suggests that Monday might be a better choice than Friday.
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At 30 days after surgery, patients in the pre-weekend group were more likely to have experienced negative outcomes such as death, readmission, complications or a longer hospital stay than those in the post-weekend group.
When these negative outcomes were grouped together in a figure known as the composite primary outcome, the odds amounted to 8.49 per cent for Friday patients but only 8.13 per cent for Monday patients.
This difference continued when the researchers looked at patients after 90 days, and again after a year. At the 90-day mark, the composite primary outcome was 12.14 per cent for Friday patients and 11.58 per cent for Monday patients. At a year, the numbers were 22.64 per cent for Friday surgeries and 21.84 for the Monday group.
The numbers are close, but it means that if you took a group of 1,000 patients, there would likely be 8 more of them with complications if they were treated on Friday rather than Monday, a difference of almost five per cent.
Vatsala Mundra, a research fellow at Houston Methodist Hospital who was part of the research team, said that while the numbers come from Ontario, they are similar to findings in other studies conducted worldwide over the decades. (The term “weekend effect” is commonly used to describe the difference.)
“We did our study in Ontario but this effect probably exists throughout the nation as well as the world,” she told the National Post. “It’s not just an Ontario problem, but an international finding for sure.”
One difference in the new study was the length of followup. Most similar research looked only at complications in the first days or weeks after surgery.
“Our hypothesis was that we would definitely see an impact in the short term, but we figured that over time that impact would go away,” said Mundra. “What we saw is that it persists. Not what what we were expecting, but it makes sense.”
Another finding was that the weekend effect is most pronounced when it comes to elective surgeries such as plastic surgery, urology or orthopaedic surgery.
“Part of it could be that emergency surgeries are usually done by trauma surgeons and the like, and they are on a different schedule than the rest of the hospital,” said Mundra.
Emergency trauma teams often operate on a rotating schedule that keeps their numbers and expertise at a constant level.
“For elective surgeries, surgeons are usually not operating on the weekend,” said Mundra. “Even on Friday you have a decrease in the number of nurses. The intensive care unit number may not change as drastically as the ward number changes over the weekend.”
That said, Mundra is reluctant to suggest that everyone needing a medical procedure opt for a Monday appointment.
“The most important thing is to make sure you’re receiving the care that you need,” she said. “If they only operate on Fridays, it’s OK to go ahead and have surgery on Friday.”
More vital than the day of the week, she added, was “making sure to advocate for yourself. And that goes for wherever you are. Advocating for yourself and getting the best care than you can.”
The team’s research follows on a somewhat more lighthearted study that looked into surgical outcomes on Friday the 13th, a day many people consider unlucky.
“We wanted to see if that superstition was present in the minds of patients and/or surgeons and health care teams, and if that would impact the type of care and post-surgical outcomes,” she said.
“And what we found was that it doesn’t. It’s all OK.”
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