Recent research has revealed that the day of the week on which a patient undergoes surgery may significantly impact their health outcomes. This phenomenon—the “weekend effect”—has alarmed health care professionals and patients, parents, and children everywhere. A new study published March 4 in JAMA Network Open looks at data from Ontario, Canada. This meant that patients who had surgery scheduled on Fridays were 5% more likely to experience worse health outcomes compared to patients who had the same surgery scheduled on Mondays.
The weekend effect is an incredibly multifaceted issue, with effects reaching far past just surgical care. The retrospective study looked at the electronic records of 429,691 patients who underwent one of 25 ASC-eligible and common surgical procedures between January 2007 and December 2019. Most interesting, it exposed clear danger associated with planned operations prior to the weekend. Many healthcare systems purposely run a different system on weekends than they do during the week. This disparity has resulted in national outcry and demands for increased awareness and more hospital staffing standards.
Understanding the Weekend Effect
The weekend effect encompasses a variety of factors that harm patient outcomes. These factors are significantly affected by the timing of elective surgeries. The study indicated that patients who received surgery on Fridays exhibited a significantly higher risk of complications, hospital readmission, and even death when compared to their counterparts who had procedures on other weekdays.
Using incident rate ratios, researchers were able to determine that the elevated risk remained present in short and long-term follow-up assessments. Harmful outcomes often surfaced at 30 days, 90 days and even one year post-op. The ramifications are grave, calling into question the level of care to which patients can expect to receive when the weekend approaches.
“Make sure you’re advocating for yourself if you’re getting surgery on a Friday and over the weekend.” – Vatsala Mundra
The Role of Surgeons and Staffing
The study found a meaningful shift in the experience level of operating surgeons. Additionally, younger and less experienced surgeons were disproportionately more likely to be assigned to pre-weekend Friday shifts. These findings call into question the impact of surgeon experience on patient care in critical hours.
“It’s really important for us to make sure we have the staffing and the ability to do so. That would be the big takeaway here.” – Vatsala Mundra
As with most studies, theirs was observational, which means researchers can’t conclude that having surgery on a weekday leads to poorer outcomes. The strong correlation should still raise red flags.
It is imperative that healthcare professionals heed these findings. Most importantly, they should be ready to respond to any bad events associated with weekend surgeries.
Broader Implications Beyond Surgery
The weekend effect, though more pronounced in surgical care, is not a parochial challenge. It is a manifestation of a more urgent underlying concern with healthcare systems. A plethora of more than 60 weekend effect studies are evidence that weekend admitted patients have poor outcomes. Further, this trend affects most every clinical specialty.
“Across clinical specialties, healthcare quality and patient safety literature suggested long ago that patients may potentially face an increased risk of adverse outcomes when admitted to the hospital on weekends.” – Salva Balbale
Our study of the weekend effect highlights the need to insist on quality healthcare that meets the highest standards seven days a week. While some research finds no meaningful association between surgical care on weekends and postoperative complications, others, including researchers, have discovered a weak but important connection, proving more studies are needed.
“It can be difficult to pinpoint what’s actually behind the weekend effect.” – Anupam Jena
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