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Editorials

Higher senior staffing levels at weekends and reduced mortality

BMJ 2012; 344 doi: https://doi.org/10.1136/bmj.e67 (Published 10 January 2012) Cite this as: BMJ 2012;344:e67

Re: Higher senior staffing levels at weekends and reduced mortality

As discussed in the editorial by Goddard and Lees,1 a recent report by the Dr Foster group demonstrated a higher mortality rate for patients admitted as an emergency at the weekend than for patients admitted as an emergency during the week.2 The report also suggested that hospitals with higher levels of senior staff available at the weekends were associated with lower mortality rates for emergency admissions at the weekend.2 Another recent study by Freemantle et al found patients admitted on a weekend were more likely to die in-hospital that patients admitted on a week day.3

The Society for Cardiothoracic Surgery in Great Britain and Ireland established its clinical governance and quality improvement programme for adult cardiac surgery performed in NHS hospitals in 2001.4 This programme has been associated with significant improvements in risk-adjusted mortality rates over time.5 We have used this database to investigate whether patients who undergo cardiac surgery at the weekend have an increased risk of in-hospital mortality compared to patients who have cardiac surgery during the week.

For this analysis all patients undergoing adult cardiac surgery at NHS hospitals in England and Wales between the 1st April 2008 and 31st March 2011 were included. In total 93 463 patients underwent surgery on a week day with an in-hospital mortality rate of 3.1% (95%CI 3.0% to 3.2%) and 3 234 patients underwent surgery at the weekend with an in-hospital mortality rate of 5.3% (95%CI 4.6% to 6.1%). However, emergency surgery was much more common at the weekend (689 patients, 21.3% of weekend patients) than during the week (2 446 patients, 2.6% of week day patients). On analysis of each individual day, no day of the week was associated with significantly higher risk-adjusted in-hospital mortality (Figure 1). Multiple logistic regression analysis (Table 1) demonstrated that weekend surgery was not associated with an increased risk of in-hospital mortality compared to weekday surgery after adjusting for other patient risk factors (Odds Ratio 0.93, 95%CI 0.77 to 1.12).

This analysis demonstrates that for a speciality with an established clinical governance and quality improvement programme and a primarily consultant delivered service, the risk of in-hospital mortality is the same for patients who have surgery at the weekend as it is for patients who have surgery on a weekday.

References
1. Goddard AF, Lees P. Higher senior staffing levels at weekends and reduced mortality. BMJ 2012; 344.
2. Dr Foster Health. Reducing mortality at night and weekends. www.drfosterhealth.co.uk/.
3. Freemantle N, Richardson M, Wood J, Ray D, Khosla S, Shahian D, et al. Weekend hospitalization and additional risk of death: An analysis of inpatient data. Journal of the Royal Society of Medicine 2012; 105(2): 74-84.
4. Bridgewater B. Cardiac registers: the adult cardiac surgery register. Heart 2010; 96(18): 1441-1443.
5. Bridgewater B, Keogh B, Kinsman R, P W. Sixth National Adult Cardiac Surgical Database Report. Dendrite Clinical Systems Ltd: Henley-on-Thames, 2008.

Competing interests: No competing interests

27 March 2012
Stuart W Grant
Research Fellow
Graeme L Hickey, David P Taggart, James Roxburgh, Graham Cooper, Ben Bridgewater on behalf of the Society for Cardiothoracic Surgery in Great Britain and Ireland
University of Manchester
Manchester Academic Health Science Centre,Department of Cardiothoracic Surgery, University Hospital of South Manchester, Southmoor Road, Manchester, England, M23 9LT