29.05.13
Risk of death after surgery ‘far higher on a Friday’
A major study of more than four million elective NHS operations has offered startling new evidence of the way risk of death increases as the weekend approaches.
The authors of the study, published in the British Medical Journal, say: “The adjusted odds of death were 44% and 82% higher, respectively, if the procedures were carried out on Friday or a weekend compared with Monday… The overall risk of death within 30 days for patients undergoing elective surgery increased with each day of the week on which the procedure was performed.”
The researchers started out by looked at all acute and specialist English hospitals carrying out elective surgery over three financial years, from 2008-09 to 2010-11 – a total of 4,133,346 inpatient admissions.
Its lead researcher, Dr Paul Aylin, clinical reader in epidemiology and public health at Imperial College London, said: “The first 48 hours after an operation are often the most critical period of care for surgery patients. So 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. That is what we found.”
The researchers added: “We tried to account for the possibility that different types of patients might have operations at the end of the week, but our adjustment made little difference. This leaves us with the possibility that the differences in mortality rates are due to poorer quality of care at the weekend, perhaps because of less availability of staff, resources and diagnostic services.”
The study, conducted by the Dr Foster Unit at Imperial, was funded by Dr Foster Intelligence and the National Institute for Health Research.
NHS England medical director Professor Sir Bruce Keogh said: “We need to review how we can best provide services to patients seven days a week. That means working out what it is that increases the risks – whether it is a lack of consultant presence, lack of lab tests, or shortages of physios that makes the difference.”
Patients Association chief executive Katherine Murphy told the Telegraph: “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.”
Conservative MP Philip Lee, a GP, told the newspaper: “The figures are starker than I would have expected.
“The solution is to look at how hospitals are configured across the country, but equally we cannot go back to a situation where you have consultants working 100 hours a week. The only way to deal with this is to have larger units, with a greater number of staff to call upon to provide rotas 24 hours a day so there are appropriately skilled people in the hospital at all times.”
The study authors note: “The association of mortality with day and time of admission has been challenged by many studies, with considerable heterogeneity in the results…All but one of these studies, however, looked at day of admission or at emergency admissions, and the only comparable study which looked at day of procedure for planned admissions is the US paper by Zare and colleagues, who found similar results to ours.”
For more information on the study, see: www.bmj.com/content/346/bmj.f2424
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