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What Is the Safest Day of the Week for Surgery?

Shhhh.... Not everyone can have an operation on the same day...

by
Theodore Dalrymple

Bio

June 11, 2013 - 9:00 am
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Everyone who needs an operation (which eventually will include most of us) wants to be assured that it will be carried out in the best and safest conditions possible. All operations are serious for those having them; a minor operation, as the British physician George Pickering once put it, is an operation carried out on someone else.

Most people with the time or ability to search for the best hospitals, surgeons, etc., will not think of considering the day of the week on which the operation will be performed as a factor of safety. It has long been known that emergency operations done at night or on the weekends have worse results than those done during the day on weekdays; but what about routine or planned operations, those (the great majority) that can be done at the surgeon’s and hospital’s leisure, as it were?

A huge statistical study done in Britain and recently published in the British Medical Journal examined the 30 day death rates after all non-emergency operations performed between 2008 and 2011 (except day cases) according to the day on which the procedure was performed.

There were in total 27,582 deaths after 4,133,345 operations, a raw rate of 6.7 per 1000: a figure that by itself would have astonished our forebears, who were used to, and took as inevitable, death rates at least a hundred times higher.

What the researchers found was that people who underwent an operation on Fridays had a death rate 44 percent higher than those who underwent an operation on Mondays, while those who underwent an operation on the weekend had a death rate 82 percent higher.

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All Comments   (11)
All Comments   (11)
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Actually, this article made perfect sense to me. After resting for a weekend Doctors are recharged. Also, the accompanying staff would be more experienced because of scheduling seniority. Newer, less experienced staff gets the hours others do not want to work......weekends and nights.
1 year ago
1 year ago Link To Comment
well said. you are pretty much dead on. this was known back in the 70s (at least) when i did my surgical residency. it has to do with seniority, staffing and (at that time) in house work up time. every few years someone decides that something is new just because it wasn't previously known to them or is worth reporting again because they need a paper. it was BMJ's time to rediscover the wheel on this and Dr Daniels' (aka dalrymple) time to make much ado about very little.
1 year ago
1 year ago Link To Comment
One reason weekend emergency surgery is so tricky is that the older, more experienced doctors are off, leaving residents to do the deeds. They're still learning and don't have the experience the older doctors have.
1 year ago
1 year ago Link To Comment
The claim that operations performed on weekends have such a high rate of death seems completely logical. Nobody schedules operations on weekends. They are always emergency surgeries. Which means usually something traumatic happened and the patient was not prepared in the usual way to undergo surgery. Patient death rates would probably be even higher without that emergency surgery.
Statistics do not tell the whole story.
1 year ago
1 year ago Link To Comment
But what is not "logical" is that emergency surgeries on the weekend (or at night) have worse outcomes than EMERGENCY surgeries DURING WEEKDAYS. The weekday emergency patients weren't any more prepared for those surgeries than the weekend (or night) patients.
1 year ago
1 year ago Link To Comment
I thought it strange that EMERGENCY surgeries were not addressed in this article. EricB, where did you get your information on weekday emergency patients?
1 year ago
1 year ago Link To Comment
mach37 -- it is right in the article, second paragraph, second sentence:

"It has long been known that emergency operations done at night or on the weekends have worse results than those done during the day on weekdays;..."

The entire phrase or clause is referring to emergency surgeries, contrasting it with the next cluase, which pivots to ask about non-emergency surgeries.
1 year ago
1 year ago Link To Comment
Dr. Daniels (aka dalrymple),

it is my understanding that you are a retired psychiatrist. so i am curious as to why most of your writing seems to be either questioning or accusatory of virtually every field except psych. care to explain?
1 year ago
1 year ago Link To Comment
Psychiatric surgeries rarely involve, um, surgery.
1 year ago
1 year ago Link To Comment
I think it's the embarrassment of riches that prevent him from making that field a target.
1 year ago
1 year ago Link To Comment
"It goes without saying that not everyone who needs an operation can undergo operation on Monday. So long as the information is not known by everyone, therefore, the wise patient would be well-advised to keep it to himself. "

I'm very surprised to see that the usually astute Theodore Dalrymple doesn't realize that he's just published this information for all the world to see on the internet. That's not keeping the information quiet, is it?

--
"ASK DR. DALRYMPLE… Do you have a question about health and medicine you’d like to see addressed?"

For the sake of the editors at PJM, Dalrymple is the PEN NAME of an actual
(retired) doctor, Dr. Anthony Daniels. I don't believe that Dalrymple is entitled to the prefix "Dr." since he isn't a real person; only Dr. Daniels is.
1 year ago
1 year ago Link To Comment
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