When Scheduling Elective Surgery, Which Day Is Best?
If you are scheduling elective surgery, the acronym TGIF is one to keep in mind and to avoid. A new study published in the British Medical Journal reports that patients who undergo elective surgery performed on Fridays or the weekend are at significantly higher risk of dying than those who have surgery on Monday.
Why you should choose surgery early in the week
At Imperial College London, researchers analyzed data on more than 4 million elective surgical procedures and made an interesting discovery:
- Of the 27,582 patients who died within 1 month of having elective surgery, the odds of dying were 44 percent higher when surgery was on a Friday than if it were done on a Monday
- Patients who had elective surgery done on a weekend had an 82 percent greater chance of dying than if they had waited to have the procedure done on a Monday
- For the other days of the week (when Monday was used as the baseline), the increased risk of dying was 7 percent for Tuesday, 15 percent for Wednesday, and 21 percent for Thursday.
According to the study’s authors, the differences in the risk of dying could be related to the quality of care patients receive over the weekends. Dr. Paul Aylin, who headed the study, noted that “The first 48 hours after an operation are often the most critical period of care for surgery patients.”
Thus, if patient care is not adequate over the weekends, which corresponds to both Friday and Saturday surgeries, then this could explain the higher risk of dying. The study’s authors also made allowances for the following factors, and the results were still the same:
- Different types of operations
- Deaths both in the hospital and those that occurred after discharge
- Death rates for a number of specific high-risk surgeries
- Similar findings in another study
Another new study, which was presented at the Heart Failure Congress 2013 during May 25-28 in Lisbon, Portugal, noted variations in risk of dying in heart failure patients. A total of 949,907 hospitalizations for congestive heart failure were analyzed for the study.
Data came from all hospitals in New York state from 1994 to 2007. The investigators discovered that overall, daily heart failure admissions to hospital was highest in February, that death rates and length of stay was lowest in patients who entered the hospital on Monday but it was highest among those admitted on Friday or for those admitted overnight.
According to Dr. David P. Kao, who presented the study at the conference, “Doctors and hospitals need to be more vigilant during these higher risk times and ensure that adequate resources are in place to cope with demand.”
The risk of dying following an elective surgical procedure appears to be associated with when the operation takes place. If you choose elective surgery, it may be wise to consult your doctor about having it performed on Monday or at least early in the week.
Aylin P et al. Day of week of procedure and 30 day mortality for elective surgery: retrospective analysis of hospital episode statistics. BMJ 2013; 346: f2424
Kao D et al. Impact of day, month and hour of admission on inpatient outcomes in 949.907 hospitalizations for congestive heart failure, Presented at Heart Failure Congress 2013 Final Programme Number P1230