Patients admitted to hospital for surgery a specific day of the week are significantly more likely to die, a major study suggests.
Those undergoing both emergency and elective operations—such as hip and knee replacements—had a 10 per cent higher risk of death if they went under the knife on a Friday, compared to the beginning.
Experts have long observed the so-called ‘weekend effect’—worse post-surgical outcomes for ops done on Friday, due to a lack of more senior staff on Saturdays and Sundays as well fewer additional services for patients like scans and tests.
Patients have also reported fearing that staff may be more tired towards the end of the week, increasing the chance of potential harmful mistakes being made in their care.
But the US researchers behind the new study believe while a ‘weekend effect’ does exist, the higher death rates observed may not always be a reflection of poorer care.
Instead, they claim it could be due to patients who need treatment closer to the weekends being more likely to be sicker and frailer.
But they admitted a lack of senior staff operating on Fridays, compared with Mondays, and a resulting ‘difference in expertise’ may also ‘play a role’.
In the study, researchers at Houston Methodist Hospital in Texas, analysed data from 429,691 patients who underwent one of 25 common surgical procedures in Ontario, Canada, between 2007 and 2019.
Scientists found both emergency and non-emergency operations — such as hip and knee replacements — were almost 10 per cent more deadly when performed close to the weekend compared to the beginning of the week
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Patients were divided into two groups — those who underwent surgery on the Friday or the day before a public holiday.
The second had their operation on the Monday or post-holiday.
Researchers assessed short-term (30 days), intermediate (90 days), and long-term (one year) outcomes for patients following their operation, including deaths, surgical complications and length of hospital stay.
They found patients undergoing surgery immediately before the weekend were 5 per cent more likely to experience complications, be re-admitted or die within 30 days.
When mortality rates were analysed specifically, the risk of death was 9 per cent more likely at 30 days among those who underwent surgery at the end of the week.
At three months this rose to 10 per cent, before reaching 12 per cent a year after the operation.
By type of operation, researchers discovered there was a lower rate of adverse events among patients who underwent emergency surgery prior to the weekend.
But, this was no longer true once they had accounted for patients who had been admitted before the weekend, yet had to wait until early in the following week to undergo such surgery.
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Under the previous Government, then Health Secretary Jeremy Hunt, repeatedly claimed understaffing at hospitals during the weekend caused 11,000 excess deaths every year
‘Immediate intervention may benefit patients presenting as an emergency and may compensate for a weekend effect,’ the medics wrote.
‘But when care is delayed or pushed back until after the weekend, outcomes may be negatively impacted owing to more-severe disease presentation in the operating room.’
Studies have also suggested patients admitted then are sicker and at greater risk of dying because a reduction in community referrals such as those from GPs, over the weekend.
Others have also said some may not be able to afford to take time off work, so delay their visit to the hospital to the weekend, when they are sicker.
Writing in the journal JAMA Network Open, the researchers added: ‘Our results demonstrate that more junior surgeons — those with fewer years of experience — are operating on Friday, compared with Monday.
‘This difference in expertise may play a role in the observed differences in outcomes.
‘Furthermore, weekend teams may be less familiar with the patients than the weekday team previously managing care.’
Reduced availability of ‘resource-intensive tests’ and ‘tools’ which may otherwise be available on weekdays could also lead to increased hospital stays and complications, they said.
Experts have long remained conflicted over the ‘weekend effect’ in NHS hospitals, with some arguing short-staffing at weekends is to blame.
The ‘weekend effect’ was one of the key arguments used by the former Conservative Government to push for the programme — and a new contract for junior doctors — in 2017.
Then Health Secretary, Jeremy Hunt repeatedly claimed understaffing at hospitals during the weekend caused 11,000 excess deaths every year.
But a flurry of studies have called this into question.
In 2021, one major NHS-backed project led by Birmingham University concluded the ‘sicker weekend patient’ theory was correct.
The study found that, despite there being far fewer specialist doctors on duty at weekends, this did not affect mortality.
