Letters Day of the week and surgical mortality

Hospital set up over the week explains difference in mortality for elective surgery

BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f3996 (Published 25 June 2013) Cite this as: BMJ 2013;346:f3996
  1. Ajay M Verma, gastroenterology specialty registrar and endoscopy research fellow1
  1. 1Kettering General Hospital NHS Foundation Trust, Kettering NN16 8UZ, UK
  1. ajaymarkverma{at}gmail.com

After the media tsunami to Aylin and colleagues’ analysis, I read the paper carefully to discover why the 30 day mortality for elective surgery on Monday and at the weekend is significantly different.1

The media suggest that at weekends work-shy consultants are absent, leaving junior doctors to run amok and kill patients. I have noticed that weekend elective lists are mainly waiting list initiatives undertaken by consultant surgeons (not junior doctors or external locum consultants) employed by the trust.

I assumed that the weekend cohort of patients were sicker, but this assumption was dispelled on reading “weekend patients tended to have less comorbidity, fewer admissions, longer waiting time . . . and lower risk surgery than the Monday patients.”1 This fits with the typical case profile selected for weekend waiting list initiatives.

So if it is not the patients, the operators, or the complexity of cases then it must be because hospitals at weekends are set up to deal only with emergencies. Increasing the burden on tight resources with elective cases results in immediate complications not being recognised or managed appropriately, in comparison with during the week, increasing morbidity and mortality.

I fear that this paper may be used to perpetuate the myth that seven day working for consultants is the answer. Consultants don’t work in isolation: all members of the workforce need to be present to make seven day working effective. This includes secretaries, porters, occupational therapists and physiotherapists, pharmacists, laboratory technicians, and cleaners (apologies for those I’ve missed).

In the current climate of austerity seven day working is not feasible. Perhaps we should accept that weekends are only for emergencies and ensure that we do the best for this group of unwell patients. Elective work should be for weekdays, when there is expertise to manage postoperative care appropriately.


Cite this as: BMJ 2013;346:f3996