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Medicine Stats United Kingdom

Surgeries On Friday Are More Frequently Fatal 152

Posted by timothy
from the saturday-sunday-happy-days dept.
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.'"
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Surgeries On Friday Are More Frequently Fatal

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  • Car Analogy (Score:5, Insightful)

    by amiga3D (567632) on Sunday June 02, 2013 @11:44AM (#43889531)

    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.

    • Odd, I thought “Blue” Mondays was the worst day, with all of the workers recovering from the weekend – in particular alcohol consumption.

      This was at least true during the 70s. Everybody agreed that Wednesday cars were the best.

      • Exactly. Don't make any plans for Surgery, Tech Support etc on Monday's or Friday's. On Monday's, most people are recovering from hangovers and parties and on Friday's everybody is in a rush for the weekend. There is definitely some truth in all of this, even from my own personal experiences.

        • by kermidge (2221646)

          Gee, thanks. It was bad enough reading the freaking article. I go under 0830 Friday for a op done by a Da Vinci. Yay.

          • Surgeries which are routine and for which the underlying condition is less serious are more likely to be scheduled further in advance, which for many people means Mon-Thurs. Few people want to schedule surgeries on Fridays, independent of the myth in TFA. Cases which are emergent are more likely to be done on Fridays, evenings, weekends, the less desirable schedules - when a sooner opening is desired.

            I would bet, if they examined the times of the year, morbidity and mortality in the adult segment would be h

            • by kermidge (2221646)

              That's an interesting and, dare I say, insightful way of looking at it. With Shirley, below, I think it'd be good to look at figures to see where they fall. It could well be that different populations skew to winter or summer, or even the other two seasons (farmers, after harvest? - which would be spring, down under), for instance. We'd also need to check whether volume of serious stuff is indeed relatively constant over time. Unless it's covered by the guys who did the study it may even be time to ask

    • Re:Car Analogy (Score:5, Insightful)

      by JWW (79176) on Sunday June 02, 2013 @03:15PM (#43890851)

      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 (Score:5, Informative)

        by dgatwood (11270) on Sunday June 02, 2013 @06:49PM (#43892193) Journal

        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.

        • by AmiMoJo (196126) *

          Fatigue is a major issue for anyone doing a high skill high stakes job. That's why the government wants to abolish the EU rules limiting maximum working time for Doctors to 48 hours a week.

      • At face value it would imagine that's definitely responsible for at least the higher weekend fatality rate. Who would *schedule* a surgery long in advance for a Sunday? I imagine a Sunday surgery is the result of a doctor on-call performing an emergency operation without any warning or preparation. Probably a life saving procedure or it could wait until the week.

        However, if you read the linked study they were only looking at elective surgeries. Which would imply they were scheduled in advance and not

        • The government response has been to say that many surgeons choose to perform more risky surgeries on a Friday because any subsequent complications that take up their time will not run into other scheduled operations.

          In other words they have Saturday and Sunday free. Bit like performing updates to an IT system on Friday night or Saturday I guess.

          Sounds plausible to me.
      • Typically surgeries that cause fatalities require recovery in hospitals, your Friday surgery recovery will take place with fewer staff to catch any problems before they become fatal. I was unable to tell if the increase in deaths occurred on the weekends, the only information I saw is that they included deaths up too 30 days after the surgery. As for weekend surgeries I suspect that more of them are emergency procedures where the patients life was all ready in peril.
  • Correlation (Score:2, Interesting)

    by 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 (Score:5, Informative)

      by gazbo (517111) on Sunday June 02, 2013 @11:54AM (#43889637)
      The study only looked at elective surgery, not urgent surgery.
      • The study only looked at elective surgery, not urgent surgery.

        Good, since those are the ones we can best change the outcome of by rescheduling them.

        Complications can arise during recovery, especially after a complicated surgery or if the hospital isn't perfect. If complications arise on a weekend, the doctors and staff who could not get the time off are the ones working, and the staff are less willing to call the doctors. (These are generalizations, and of course vary from hospital to hospital.)

        This is the exact reason why you NEVER schedule elective surgery on majo

        • by Culture20 (968837)
          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.
          • 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.

            Also, craming the same number of surgeries into fewer days is going to increase pressures, which tends to increase mistakes.

          • by Belial6 (794905)
            Moving surgery to Thursday does not immediately make Friday a day off for surgeons. Thinking that cutting people open with a knife is the only thing a surgeon does is like thinking that typing in code is all that a software developer does.
            • by Culture20 (968837)
              But it's the most stressful thing they do. They might look forward to a stress-free Friday, making Thursday dangerous.
              • by Belial6 (794905)
                Given that the number is a percentage of total elective surgeries, no. It isn't because surgery is the most stressful thing they do.
    • by Aguazul2 (2591049) on Sunday June 02, 2013 @11:57AM (#43889659)

      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".

      • Hopefully a large amount of people continue to elect for Friday surgery keeping the rest of the days safer for us all. Or we would have to institute some kind of National selection committee for mandating Friday surgeries for the good of all the citizens.

        • Hopefully a large amount of people continue to elect for Friday surgery keeping the rest of the days safer for us all.

          A better solution might be to schedule minor, non-life-threatening surgeries on Friday. So the heart transplants would be done on Tuesdays, and Friday left open for the nose jobs.

          • by Macgrrl (762836)

            It's unlikely that nose jobs are going to be done by the same surgeons as those who perform heart transplants. It's even possible they wont use the same operating theatre or even hospital location.

      • by lxs (131946)

        It is now official. BMJ has confirmed: your patient is dying

        One more crippling bombshell hit the already beleaguered surgical staff when BMJ confirmed that your patients blood pressure has dropped yet again, now down to less than a fraction of 1 percent of healthy systolic pressure. Coming on the heels of a recent BMJ survey which plainly states that your patient has lost consciousness, this news serves to reinforce what we've known all along. your patients vital signs are c

        • I don't know whether to applaud you, or to cry because so few posters recognize the beautiful testament to the "Netcraft confirms it" posts...

      • by rwv (1636355)

        Might be doctor's intentionally botching Friday surgery to create the perception that Friday is a bad day to schedule surgery. It seems logical enough and would eventually lead to people not wanting to pick a Friday for their operation (and more doctor's getting Friday to do non-surgery activities -- like golf).

        And FWIW -- no, I'm not suggesting this as a serious response -- just piling in with the groups of people who are skeptical about raw data without knowing any caveats or filters or "cherry picking

  • by Anonymous Coward on Sunday June 02, 2013 @11:47AM (#43889559)

    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.

    • by Kjella (173770)

      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.

      • by Daniel Dvorkin (106857) on Sunday June 02, 2013 @12:11PM (#43889761) Homepage Journal

        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.

        • by Trepidity (597) <delirium-slashdot@@@hackish...org> on Sunday June 02, 2013 @01:03PM (#43890091)

          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.

          • by AmiMoJo (196126) *

            And most importantly even if the chance of dying is 82% greater it is still less than 1 in 100. It reminds me of when Dutchess Kate had some condition that makes her 78% more likely to have twins, except that the base probability was less than 1% so IIRC her chances only increased to about 1 in 50 or something.

        • 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.

          Fact is that many people are very bad as statistics, including many people writing scientific papers. And yes, there are scientists who are morons.

          In this case, I cannot find what percentage of elective surgery was performed on Fridays, but 4.5% was performed on Saturdays and Sundays (that was mentioned to explain why these two days were combined in the statistics). Since with random selecction of days 28% of surgery would be performed on Saturday / Sunday but in reality there is only 4.5%, this strongly

          • TFA gives all the sample sizes (broken down by procedure), so if you aren't content with eyeballing them you can pull out the trusty slide rule.
      • by kurthr (30155) on Sunday June 02, 2013 @12:21PM (#43889839)

        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.

    • 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.

      They control for the type of procedure, so you can rule out the obvious confounding factor of scheduling procedures that are inherently more dangerous for later in the week. It doesn't tell you about the differences between the individual patients, of course ("this hip replacement's going to much trickier than that one, so I'll do it on Friday") but the numbers do not provide any evidence for the hypothesis that this kind of schedule-shuffling is going on. Comparing between types of procedures, the number

      • by aflag (941367)
        Moreover, they have found in other studies that emergency surgeries over the weekend are more likely to result in death than on other days of the week. So the hypothesis that it could be explained simply because of how doctors schedule surgeries can be ruled out. Besides, it seems that care over the weekend is actually poorer than care during the week days. So it seems like surgeon would not want to schedule trickier surgeries over friday. Also, the surgeon himself would like to rest over the weekend, so i
        • by Rockoon (1252108)
          My theory is that the shitty doctors and nurses and up working the weekends, because if they were actually decent at their job they wouldnt have ended up with the least popular days of the week.

          Probably they will find in the case of emergency procedures, that the night crew also does poorly.
          • by ColdWetDog (752185) on Sunday June 02, 2013 @12:37PM (#43889937) Homepage

            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?

          • by hrvatska (790627)

            I would say you are wrong. Nurses who work more weekends or off shifts tend to do so for three reasons.

            Family reasons, either child care or the need to care for some other family member.
            Money, some hospitals have attractive shift differentials.
            New grads just starting out. But in no way does new mean shitty.

            Night shifts in hospitals do tend to have more errors. When they look into it it's because the nurses are tired. People make more mistakes when they are tired. Most nurses who work night shift s

            • by gmhowell (26755)

              Coming from a family with a doctor and multiple nurses, I can say you are spot on. Another factor is that some doctors and nurses, particularly in emergency medicine, prefer the cases that come in at night and on the weekends.

              GP had an interesting theory, but given the way it's worded, it's merely a troll rather than an alternative hypothesis.

              (Oh, and three shifts for nurses is not as common an arrangement as it used to be. GF has almost exclusively worked 12 hour shifts for ~10 years.)

            • by gordo3000 (785698)

              actually, two of your points mere validate the GP, not invalidate.

              Family reasons --> the implication being that this person does not have a schedule that allows them to sleep enough before their shift beings (I want a nurse htat just woke up from a good rest, not one who rested , then went about their entire, stressful day then came to work)

              New grads --> fundamentally far worse at their jobs than experienced individuals. there is not middle ground for this. It has been shown with doctors (and I'll a

    • So can explanations of statistics... if the emergency staff available at the hospital is lacking, it won't matter that the surgeon is there. Also, it doesn't explain why those entering on Saturday are worse than those on Friday!
      Sounds bites from question time are, just that...

    • by lxs (131946)

      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.

    • I haven't run into a specialist yet that does any meaningful work past Wednesday. It's mostly golf the rest of the week.

      Maybe the 'who ever is left' category of people who are left at the end of the week aren't so good at surgeries.

      • by gmhowell (26755)

        Weird, maybe you need to find a better group of specialists. I can tell you from first hand experience, at least one of Dick Cheney's cardiologists does surgeries after Wednesday. Now, I'm not saying he's the best cardiologist in the world, but I'd be willing to bet that someone as wealthy and connected as the Evil Dick wasn't being treated by people who could barely sober up enough to get through Hollywood Upstairs Medical College.

    • by Seumas (6865)

      Now they just need to find a way to offload the blame for lopping off the wrong body part, performing the wrong surgery, or leaving objects in patients. I'm sure they can find a convoluted way to blame the patient or something.

      • by kermidge (2221646)

        I don't know where you've been, but every op I've had in the last twenty years, from the time a nurse and orderly show up in staging, they check my wristband, ask me my name and birth-date, then check against paper package laying on or next to me. This happens every place I go, by every new person, all the way onto the operating table. The process continues from recovery and on to the ward and into my room.

        Every new doctor, nurse, or CNA checks the same stuff if they're going to do anything or give me any

    • by Idbar (1034346)
      I couldn't agree more. Also, I'd assume that workcoholic people or people with higher work stress will delay their surgeries to reduce time-off the work. Those delays may cause a higher spike of higher risk people trying to get their surgery done on Friday.
  • Approximately 2/5 (two fifths!) of sick days are taken on Mondays and Fridays! Obviously the implication is that the slack workers aren't really sick, but are taking the day off to coincide with the weekend!

    ---

    I'm not going to book surgery on any day other than a Wednesday. Unless I want to die I guess.

  • by Smivs (1197859) <smivs@smivsonline.co.uk> on Sunday June 02, 2013 @11:49AM (#43889587) Homepage Journal

    The skeleton staff working on weekends might be to blame.

  • not day of the week. People are more likely to injure themselves on their own time. That probably explains most of the difference.
  • No, you can thank him yourself... you'll be seeing him soon... if you've been good.

  • by Anonymous Coward

    Several years ago, after a stupid table-saw accident and an ER visit, I went to my doctor to have the wound check for healing. The ER nurse had clumsily wrapped my thumb and fingers with gauze (I came up with a much more elegant method, which looked neater, stayed on better, and could be accomplished with one hand -- but I digress...) Anyhow, she had also not put non-stick pads on the wounds before gauzing. The blood and pus had seeped into the gauze and hardened, making it difficult and painful to remove.

  • by kurthr (30155) on Sunday June 02, 2013 @11:58AM (#43889665)

    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.

  • by jotaeleemeese (303437) on Sunday June 02, 2013 @12:01PM (#43889689) Homepage Journal

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

    • Interesting, but (and this a genuine question, not a glib attempt to undermine your statement) what does that mean for the even greater risk at weekends?
    • 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.

  • by Henriok (6762) on Sunday June 02, 2013 @12:15PM (#43889797)
    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.
    • You obviously haven't read the article which contains the graph showing that the risk of death due to elective surgery grows monotonically approaching the weekend. By the weekend, scheduled elective surgeries are almost twice as likely to kill you.
      Two days are the worst, they are on the weekend, and the closer your surgery recovery is to the weekend the worse the expected outcome- 40%worse on Friday.

      Read the fine documentation...

    • Sure, one day will likely be the worst, but tens of percentage points worse? That suggests that there's a causative agent of some sort, such as fatigue, a desire to hurry up and leave, or some other factor, and that the agent is endangering the lives of patients and should be addressed.

      It sounds as if you're trying to excuse it simply because "one day must be the worst", but by that logic, we should excuse all sorts of other things as well, regardless of the reason why they are the worst. For example, if th

  • I'll bet it has something to do with the fact that doctors like to take Fridays off. So by extension if they are doing surgery on a Friday (or god help you a weekend), whatever the issue is it must be life threatening, and most likely far more severe than a surgery that can wait until Monday: Hence more likely to get you killed, no matter the skill level of the surgeons or their team.

  • In a shocking statistic, 40% of sickdays are taken on Fridays or Mondays... clearly slackers trying to extend their weekends.

    We should try and stamp out this scourge on productivity everywhere!

    • by Jaktar (975138)

      We should try and stamp out this scourge on productivity everywhere!

      The beatings will continue until morale improves!

  • by wonkey_monkey (2592601) on Sunday June 02, 2013 @12:33PM (#43889923) Homepage

    "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?

    • by Anonymous Coward

      Random apostrophe's is the new fad.

    • by Anonymous Coward

      The quote in TFS was actually lifted from a separate article here [vice.com]. Someone just decided to change the link to the original BMJ article instead.

    • by Anonymous Coward

      Those are journalistic double-apostrophes. They're often confused with quotes, but they actually are meant to imply some artistic license in the phrase.

  • when on the 13th and the surgeon's name is Jason ...
  • Doctor: Sir, I'm afraid I have some bad news. Your heart is going to explode. We'll need to perform emergency surgery right away.
    Patient: But....today is saturday! I don't wanna die - can it wait until monday?
    Doctor: If you don't have it now there is a a 75% chance you will not live until monday
    Patient: yea...I think I'll take my chances and wait until monday thank you very much
  • I am IT staff at a hospital and end up working on the in-suite PCs alot since coworkers don't like being in a room with a patient open. The surgery schedule gets busier throughout the week with the busiest day being Thursday; at my hospital that is really the "Friday" of the OR. For reasons mentioned above only cases of eminent need are scheduled for Fridays and nothing on the weekend. If you are having surgery on a Friday or the weekend you are in a fairly grave state already. Also: All doctors, surgeo
  • by overshoot (39700) on Sunday June 02, 2013 @03:22PM (#43890879)

    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.

  • at least to /. readers who seem to think that Friday surgery victims are 44 percent more likely to die than ... well who?

    I assume that this is compared to other people having surgery.

    So if those people have a .01% chance of dying, the Friday people have a .0144% chance of dying.

    Does that take some of the drama out of the story or do you still not understand it?

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