Surgeries performed close to the weekend could present greater risks

If you were to randomly ask doctors if they themselves needed to be admitted to a hospital during a weekend or during a weekday, most would probably choose weekday. There is already research suggesting a “weekend effect”; that people admitted during a weekend have worse outcomes, and probably even doctors who haven’t seen this data would easily believe it.

Let’s look at a large recent study from Imperial College London, published in the British Medical Journal on May 28. Researchers examined data from all surgeries performed by the British National Health Service from 2008 to 2011.  They wanted to see if there was any difference in outcomes between surgeries performed during the week or on a weekend, and if the day of the week mattered.

They only looked at “elective” surgeries; that is, surgeries planned in advance. Emergency surgeries were not included. They had data then from over 4.1 million surgeries, and they found a death rate within 30 days of surgery of 0.67%.

This means that for every 1000 people who underwent surgery, nearly 7 of those people died within 30 days. This was the average risk for all surgeries combined. Many surgeries such as hernia repair, hip replacement, or tonsillectomy carried a lower risk whereas surgeries of the heart, lung, or major blood vessels carried a higher risk.

But the main result of the research was rather shocking. They found that yes, people having surgeries on weekends had a much higher risk of dying—82% higher— within 30 days following their procedure than people having surgery on Monday.

And during the weekdays, surgery seemed to carry a higher risk towards the end of the week. Monday was the safest day, and each day following was slightly riskier. People having surgery on Friday had a 44% higher risk than Monday surgeries.

Dr. Paul Aylin, principal author of this study explains:

The first 48 hours following a procedure is most critical and when things can go wrong, such as bleeding and infections. If you don’t have the right staff, this is likely to contribute to things being missed…

if I were to have an operation towards the end of the week I would be interested in whether the hospital had the appropriate services to look after me throughout my recovery, including at the weekend.

Most hospitals have a smaller staff during weekends. And the doctors who work on weekends may be less experienced. The more experienced doctors often are able to have their weekends free.

But not only the doctors are important. Good surgical outcomes depend on an entire team, from the nurses who prepare the patient for surgery and others who care for patients after, to the X-ray and laboratory staff, to the technicians in charge of sterilizing instruments, and on and on. If there is weakness or delay anywhere in this chain, the risk rises.

We cannot say if these results would apply here in Brazil, but it seems likely. If you or a loved one needs surgery, and you can choose the day of the week, you might want to choose earlier in the week.

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See also in ProcuraMed:

“Excessive medicine” can result in problems for a patient



Esta postagem também está disponível em: Portuguese (Brazil)