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RCOG statement on BMJ article on outcomes for elective surgery throughout the week

News 29 May 2013

New research published in the BMJ today (29 May 2013) shows that it is riskier to have an operation at the end of the week than it is at the beginning.

The findings show that patients having planned surgery on Thursdays and Fridays have a 44% increased risk of death than if the procedure occurs at the start of the working week.

Researchers hypothesise that the higher mortality rates are because of poorer post-operative care in hospitals during the weekends when fewer clinical and nursing staff are around. The first 48 hours after surgery are deemed crucial since the patient’s risk of infections and bleeding is higher during this period. Other possible explanations for these poor outcomes include the case-mix of patients, the scheduling of surgical procedures and workforce planning issues.

Although the overall death rate is low, these findings add more evidence to the argument to have round-the-clock NHS consultant care throughout the week.

Dr Tony Falconer, President of the Royal College of Obstetricians and Gynaecologists (RCOG) said,

“We have raised our concerns in the past about the need for a 24/7 service in the NHS and this is further evidence for this change.

“Doctors working in maternity services are used to long hours because birth is unpredictable and can happen at any time. However, issues arise when emergencies occur and access to diagnostic and other clinical services is limited.

“Women should have access to high quality healthcare on the NHS at any time of the day and night, across all days of the week.

“We are currently looking at ways to have more senior presence in the labour ward during the out-of-hours period so that we maintain safe, high quality O&G services throughout the week.”

Reference

Aylin P, Alexandrescu R, Jen MH, Mayer EK, Bottle A. Day of week of procedure and 30 day mortality for elective surgery: retrospective analysis of hospital episode statistics. BMJ 2013;346:f2424