Surgeries On Friday Are More Frequently Fatal

antdude writes "A British Medical Journal (BMJ) research report says that 'Surgeries on Friday Are More Frequently Fatal ... compared to those who opt for really bad Mondays, Britons who have a planned surgery on a Friday are 44 percent more likely to die. And the few patients who had a leisurely weekend surgery saw that number jump to 82 percent. The skeleton staff working on weekends might be to blame.'"

Comments

Car Analogy

[amiga3D]

It's like how cars made on Friday have more defects. People are tired after a long week and just want the day to end so they can get the weekend party started.

Re:Car Analogy

[JWW]

Perhaps since its a Friday, surgeons actively avoid scheduling easy, routine surgeries. The surgeries that would take place would then be more risky emergency surgeries. The percentage number of fatalities would be higher as a result.

Re:Car Analogy

[dgatwood]

This study is only about scheduled surgeries, i.e. non-emergency surgeries. That said, there is a continuum between the two, so it is plausible that they're more likely to be somewhat urgent, or else they would have put them off until a few weeks later so the doctor could go play golf. :-D

That said, I think the fatigue theory has a lot of merit. It is common knowledge that surgeries performed later in the day have higher rates of complications, surgical errors, anesthesia mistakes, etc. There's no reason to believe that surgeries later in the week would not be similarly affected, for precisely the same reason.

Re:Car Analogy

[kermidge]

A friend worked for Oldsmobile in Lansing for over ten years, from line to supervisor to trouble-shooter. In those days ('70s) one could order a car and make a reservation to watch it being built. Friend said overall best build quality was on a Wednesday around 10:30 am.

Monday - sobering up, where am I, where does this go
Tuesday - relearn job, getting the hang of it by afternoon
Wednesday - fired up and in the groove, but tiring after lunch
Thursday - tired, bored, and sloppy
Friday - you're kidding, right? It's freaking Friday, I'm out of here.

Correlation

[Anonymous Coward]

I would assume urgent surgeries have higher fatality rates, and they are the ones that may get crammed in on the weekends and Friday nights.

That said, there might be some causal relation (but the study is just correctional), and it makes sense to look into it. However, currently there isn't enough evidence to make me try and avoid late week surgery.

Re:Correlation

[gazbo]

The study only looked at elective surgery, not urgent surgery.

Re:Correlation

[Aguazul2]

However, currently there isn't enough evidence to make me try and avoid late week surgery.

I'm so glad there are still a few people brave enough to be operated on on Fridays. We can call it "correlation is not causation" day, or "I won't believe it until Saint Peter himself confirms it".

Statistics can be misleading

[Anonymous Coward]

On Question Time Anna Soubry (Under-Secretary of State for Health) said that some doctors schedule more at-risk surgeries on a Friday because then they will be able to deal with the patient during the weekend when they don't have surgeries planned. You do need to be careful when you want to find explanations for statistics like these. Your immediate reaction can easily be wrong.

Re:Statistics can be misleading

[Kjella]

Yes, and the same thing about weekend surgeries. If it can't wait until Monday it means it's critical and life-threatening, which of course is highly correlated with dying. If you want real stats you have to go procedure by procedure and compare similar cases, like acute [whatever] operated immediately on a weekday compared to the same condition, same operation on a weekend.

Re:Statistics can be misleading

[Daniel Dvorkin]

If you want real stats you have to go procedure by procedure and compare similar cases

Which, amazingly, is exactly what the authors of the paper did. It's open-access; click the link and read it for yourself.

Oh, wait, I forgot. On Slashdot, scientists are morons and people who read an article on a pop-sci site a month ago know everything, and any use of statistics can and must instantly be banished with the Words Of Power, Which I Will Not Utter Here.

Re: Statistics can be misleading

[kurthr]

These are scheduled elective surgeries, not emergency admissions!

Our analysis confirms our overall study hypothesis (with some heterogeneity) of a âoeweekday effectâ on mortality for patients undergoing elective surgeryâ"that is, a worse outcome in terms of 30 day mortality for patients who have procedures carried out closer to the end of the week and at the weekend itself. The reasons behind this remain unknown, but we know that serious complications are more likely to occur within the first 48 hours11 after an operation, and a failure to rescue the patient could be due to well known issues relating to reduced and/or locum staffing (expressed as number and level of experience) and poorer availability of services over a weekend.

Re:Statistics can be misleading

[lxs]

Either that of she didn't want to admit that she is responsible for a service where surgeons are overworked to the point of failing patients.

Re:Statistics can be misleading

[ColdWetDog]

No, you're missing the obvious inference here.

The only major difference between weekdays and weekends is that the administrative staff is gone by Friday at 1400. Thus, quid pro quo and all that;

Administrators are needed for safe surgery.

Who the hell knew?

Re:Statistics can be misleading

[Trepidity]

The summary does make it sound like these are raw numbers being quoted (44% and 82% more likely to die), but you're right, the actual study, which the summary should've summarized better, gives something more specific:

Compared with Monday, the adjusted odds of death for all elective surgical procedures was 44% and 82% higher if the procedures were carried out on Friday or at the weekend, respectively

That is, they both 1) adjusted for (at least some) other factors that predict outcomes; and 2) limited their analysis to elective surgical procedures, i.e. they did not include emergency weekend surgeries.

Re:Statistics can be misleading

[ericloewe]

Now we know why red tape is red.

The staff are dead as well?!

[Smivs]

The skeleton staff working on weekends might be to blame.

but tee are better!

[kurthr]

Most hospitals have restrictions on non- emergency surgeries over the weekend, because they have very limited staff.
However, surgeons are very powerful (especially those who do elective surgeries that bring in big $) and they often prefer to schedule surgeries around their own convenience rather than that of their patients or other hospital staff.

Stanford hip replacements are a known example.

Slashdot behind the news cycle

[jotaeleemeese]

Lots of people have pointed out already that more complicated surgeries are scheduled for Fridays so doctors are fully available to deal with complications.

Re:Slashdot behind the news cycle

[Anubis IV]

It's a good thing that the authors of the paper compensated for that fact by comparing similar-to-similar, rather than just working with the raw statistics, which is what the summary seems to paint them as having done. What the paper is saying is that if you compare a person who has that "more complicated" surgery on Friday vs. a person who has that same procedure done on an earlier day of the week, the one who has it done on Friday will be more likely to die.

One day must be the worst

[Henriok]

I admit that I didn't read the article but I must point out that there is just seven days and one day must be the worst and one day must be the best. I happens to be the friday in the UK, it might be some other day in another country but there must always be one certain day that is the worst. Since there's only seven possible outcomes but an uncountable ammount of factors going in, good luck to figuring out what exacly is goong on.

Re:Simple reason

[nedlohs]

By definition "elective surgery" is something that "can wait until Monday". So no.

For fuck's sake, Slashdot...

[wonkey_monkey]

"A British Medical Journal (BMJ) research report says that 'Surgeries on Friday Are More Frequently Fatal ... compared to those who opt for really bad Mondays, Britons who have a planned surgery on a Friday are 44 percent more likely to die. And the few patients who had a leisurely weekend surgery saw that number jump to 82 percent. The skeleton staff working on weekends might be to blame.'"

You really need to decide where the quotes are supposed to go in this summary. I very much doubt that a BMJ report would ever use such glib phrases as "really bad Mondays" and "leisurely weekend surgery."

In fact I don't think anything in TFS has actually been quoted from the report, beyond individual words or numbers. So why is it in quotes? Or are they just random apostrophes?

Re:Good

[Culture20]

If you make a big line in the airport for bomb-checks, you've moved the killing location from the plane to the airport waiting line.
Likewise, if you move the Friday surgeries to Thursday such that Thursday is the new day before the end of the work week, then Thursday might exhibit the same death rates.

Which kinds of surgery

[overshoot]

The skeleton staff working on weekends might be to blame

Yeah, but what if it isn't an orthopaedic surgery?

If we're talking about small rural or local hospitals, sure -- in part because these hospitals are at most feeders that stabilize patients before sending them to major hospitals. There's a world of difference between the rural hospital that's close to the mountain where I ski patrol and a Level 1 trauma (or cardiac, or stroke) center. The local hospital (which bills itself as a "regional medical center") doesn't even have an orthopaedic surgeon on duty on weekends. In contrast, less than 200 miles away are four cities with Level 1 trauma centers (altogether more than seven hospitals) including Barrows Neurological Hospital, Mayo Hospital, two university hospitals, and a top-notch limb reattachment hospital.

Having been married to a nurse who worked at most of the big ones, I can tell y'all that the staffing doesn't thin out on weekends.