Luc Dubois1, Kelly Vogt2, Chris Vinden2, Jennifer Winick-Ng2, J Andrew McClure2, Pavel S Roshanov2, Chaim M Bell2, Amit X Garg2. 1. Departments of Surgery (Dubois, Vogt, Vinden) and of Epidemiology and Biostatistics (Dubois, Vogt, Garg), Schulich School of Medicine and Dentistry, Western University, London, Ont.; Institute for Clinical Evaluative Sciences (Vinden, Winick-Ng, McClure, Bell, Garg), Toronto, Ont.; Lilibeth Caberto Kidney Clinical Research Unit (Roshanov), London Health Sciences Centre, London, Ont.; Department of Clinical Epidemiology and Biostatistics (Roshanov), McMaster University, Hamilton, Ont.; Department of Medicine (Bell), Mount Sinai Hospital, University of Toronto, Ont. Luc.Dubois@lhsc.on.ca. 2. Departments of Surgery (Dubois, Vogt, Vinden) and of Epidemiology and Biostatistics (Dubois, Vogt, Garg), Schulich School of Medicine and Dentistry, Western University, London, Ont.; Institute for Clinical Evaluative Sciences (Vinden, Winick-Ng, McClure, Bell, Garg), Toronto, Ont.; Lilibeth Caberto Kidney Clinical Research Unit (Roshanov), London Health Sciences Centre, London, Ont.; Department of Clinical Epidemiology and Biostatistics (Roshanov), McMaster University, Hamilton, Ont.; Department of Medicine (Bell), Mount Sinai Hospital, University of Toronto, Ont.
Abstract
BACKGROUND: In prior studies, higher mortality was observed among patients who had elective surgery on a Friday rather than earlier in the week. We investigated whether mortality after elective surgery was associated with day of the week of surgery in a Canadian population and whether the association was influenced by surgeon experience and volume. METHODS: We conducted a population-based retrospective cohort study in the province of Ontario, Canada. We included adults who underwent 1 of 12 elective daytime surgical procedures from Apr. 1, 2002, to Dec. 31, 2012. The primary outcome was 30-day mortality. We used generalized estimating equations to compare outcomes for surgeries performed on different days of the week, adjusting for patient and surgeon factors. RESULTS: A total of 402 899 procedures performed by 1691 surgeons met our inclusion criteria. The median length of hospital stay was 6 (interquartile range 5-8) days. Surgeon experience varied significantly by day of week (p < 0.001), with surgeons operating on Fridays having the least experience. Nearly all of the patients who had their procedure on a Friday had postoperative care on the weekend, as compared with 49.1% of those whose surgery was on a Monday (p < 0.001). We found no difference in the 30-day mortality between procedures performed on Fridays and those performed on Mondays (adjusted odds ratio 1.08, 95% confidence interval 0.97-1.21). INTERPRETATION: Although surgeon experience differed across days of the week, the risk of 30-day mortality after elective surgery was similar regardless of which day of the week the procedure took place.
BACKGROUND: In prior studies, higher mortality was observed among patients who had elective surgery on a Friday rather than earlier in the week. We investigated whether mortality after elective surgery was associated with day of the week of surgery in a Canadian population and whether the association was influenced by surgeon experience and volume. METHODS: We conducted a population-based retrospective cohort study in the province of Ontario, Canada. We included adults who underwent 1 of 12 elective daytime surgical procedures from Apr. 1, 2002, to Dec. 31, 2012. The primary outcome was 30-day mortality. We used generalized estimating equations to compare outcomes for surgeries performed on different days of the week, adjusting for patient and surgeon factors. RESULTS: A total of 402 899 procedures performed by 1691 surgeons met our inclusion criteria. The median length of hospital stay was 6 (interquartile range 5-8) days. Surgeon experience varied significantly by day of week (p < 0.001), with surgeons operating on Fridays having the least experience. Nearly all of the patients who had their procedure on a Friday had postoperative care on the weekend, as compared with 49.1% of those whose surgery was on a Monday (p < 0.001). We found no difference in the 30-day mortality between procedures performed on Fridays and those performed on Mondays (adjusted odds ratio 1.08, 95% confidence interval 0.97-1.21). INTERPRETATION: Although surgeon experience differed across days of the week, the risk of 30-day mortality after elective surgery was similar regardless of which day of the week the procedure took place.
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