No weak days? Impact of day in the week on surgical mortality

Singla, Animesh; Guy, Gordon S.; Field, John; Ma, Ning; Babidge, Wendy; Maddern, Guy J.

doi:10.1111/ans.13315

Cited by 19 publications

(10 citation statements)

References 20 publications

(35 reference statements)

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“…Some showed reduced consultant involvement to be associated with a poorer outcome . Our finding of the day of the week or time of day not affecting mortality ( P > 0.4) is consistent with a recent Australian audit …”

Section: Discussionsupporting

confidence: 91%

Benchmarking against the National Emergency Laparotomy Audit recommendations

Cappello

Kousary

et al. 2017

ANZ Journal of Surgery

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Section: Discussionsupporting

confidence: 91%

Benchmarking against the National Emergency Laparotomy Audit recommendations

Cappello

Kousary

et al. 2017

ANZ Journal of Surgery

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“…Improved surgical outcomes have been derived from audit participation, with observed changes in practice . Specific management issues have been identified through this process in other surgical specialties such as neurosurgery and cardiothoracic surgery, and more broadly across surgery in general …”

Section: Introductionmentioning

confidence: 99%

Potentially avoidable issues in urology mortality cases in Australia: identification and improvements

Gupta

Stewart

Cottell

et al. 2020

ANZ Journal of Surgery

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Background: This study aimed to identify the most common potentially avoidable factors in urology deaths, focusing on the lessons that can be learnt. Methods: This study analysed data from a well-established and comprehensive peer review audit of surgical deaths in Australian hospitals (excluding New South Wales) from 2009 to 2015, focusing on urology cases with identified areas for improvement in patient management. Of all audited deaths, 11% (79/719) had serious clinical management issues with a total of 109 individual clinical management issues identified. These were categorized based on perioperative stage (preoperative, intraoperative or post-operative), followed by thematic analysis within each stage. Results: The study found preoperative issues to be the most common (n = 48), followed by post-operative issues (n = 32) with intraoperative issues less common (n = 13). Communication issues were seen at all three stages (n = 16). Overall, the most common theme was at the preoperative stage; inadequate preoperative assessment (n = 27). More specifically, the most common preoperative assessment issues involved a failure to order necessary preoperative investigations, or to administer necessary preoperative treatment (e.g. prophylactic antibiotics). The most common communication issue was between teams and at handover, often involving failure by junior medical staff to communicate issues to the responsible surgical consultant. Conclusion: Urological surgical cases with potentially avoidable mortality constitute a small, but important subset of deaths. The analysis of these cases can inform various stakeholders to improve the quality and safety of urological surgical care.© 2020 Royal Australasian College of Surgeons ANZ J Surg 90 (2020) 719-724ANZJSurg.com

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“…Although most reports showed higher short‐term mortality in patients who underwent surgery late compared with early in the week, results were conflicting . Notably, previous studies investigated only short‐term mortality in patients who underwent different types of operations.…”

Section: Introductionmentioning

confidence: 99%

Weekday and Survival After Cardiac Surgery—A Swedish Nationwide Cohort Study in 106 473 Patients

Dalén

Edgren

Ivert

et al. 2017

JAHA

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BackgroundThe purpose of this study was to investigate the association between weekday of surgery and survival following cardiac surgery.Methods and ResultsIn a nationwide cohort study, we included all patients who underwent cardiac surgery in 1999–2013 from the SWEDEHEART (Swedish Web‐system for Enhancement and Development of Evidence‐based care in Heart disease Evaluated According to Recommended Therapies) register. All‐cause mortality until March 2014 was obtained from national registers. The association between weekday of surgery and mortality was estimated using Cox regression, and reported as hazard ratios with 95% CI. We used the restricted mean survival time difference to estimate loss of life related to weekday of surgery. Among 106 473 patients, 25 221 (24%), 24 471 (23%), 22 977 (22%), 20 189 (19%), 9251 (8.7%), and 4364 (4.1%) underwent surgery during a Monday, Tuesday, Wednesday, Thursday, Friday, and a Saturday/Sunday, respectively. More patients were operated on urgently during Friday to Sunday, and unadjusted analyses showed higher early and late mortality in those patients. The adjusted hazard ratios (95% CI) were 1.00 (0.89–1.13), 1.00 (0.88–1.12), 1.02 (0.90–1.16), 1.17 (1.01–1.37), and 1.05 (0.86–1.29) in patients who underwent surgery during a Tuesday, Wednesday, Thursday, Friday, and Saturday/Sunday compared to a Monday, after 1 year of follow‐up conditional on 30‐day survival. In elective surgery (n=46 146), the 1‐year restricted mean survival time difference (95% CI) was −0.5 (−1.8–0.8), −0.5 (−1.9–0.8), −1.0 (−2.6–0.5), 0.02 (−2.2–2.3), and −1.2 (−6.3–3.9) days in patients who underwent surgery during a Tuesday, Wednesday, Thursday, Friday, and a Saturday/Sunday, respectively, compared to a Monday.ConclusionsWe found no evidence of a clinically relevant weekday effect in patents who underwent cardiac surgery in Sweden during a 15‐year period. These data suggest that the early risk and long‐term prognosis following cardiac surgery was not affected by the weekday of surgery.Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT02276950.

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No weak days? Impact of day in the week on surgical mortality

Abstract: There appears to be an association between day of surgery and surgical outcome. The exact cause and contributing factors requires further investigation.

Cited by 19 publications

References 20 publications

Benchmarking against the National Emergency Laparotomy Audit recommendations

Benchmarking against the National Emergency Laparotomy Audit recommendations

Potentially avoidable issues in urology mortality cases in Australia: identification and improvements

Weekday and Survival After Cardiac Surgery—A Swedish Nationwide Cohort Study in 106 473 Patients

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