New research from the Association for Cardiothoracic Anaesthesia and Critical Care (ACTACC) has found that there is no ‘weekend effect’ on patient survival after cardiac surgery.
Although previously published studies suggest that patients admitted to hospital on weekends have higher mortality than those admitted during the week, the study found that undergoing cardiac surgery during the weekend does not affect survival, after adjustment for after adjustment for patient heterogeneity and procedure priority level.
The retrospective analysis prospectively collected cardiac registry data from 10 UK centres over a decade. It included a total of 110,728 patients, undertaken by 127 consultant surgeons and 190 consultant anaesthetists between April 2002 and March 2012.
The crude in-hospital mortality rate was found to be 3.1%. After adjusting for centre, surgeon, anaesthetist, patient risk, and procedure priority, weekend elective cases had significantly lower mortality risk compared with Monday elective cases (OR, 0.64; 95% CI, 0.42-0.96) after risk adjustment by the logistic European System for Cardiac Operative Risk Evaluation (EuroSCORE) and procedure priority. However, differences for urgent (OR, 1.12; 95% CI, 0.73-1.72) and emergency/salvage cases (OR, 1.07; 95% CI, 0.79-1.45) were not significant.
Considering only the logistic EuroSCORE but not procedure priority yielded 29% higher odds of death for weekend cases compared with Monday operations (OR, 1.29; 95% CI, 1.08-1.54).
Commenting on the findings, presented in the Journal of Cardiothoracic and Vascular Anesthesia, the authors say the study demonstrates that a model adjusting only for operative day would lead to “the unsafe conclusions of a ‘weekend effect’ as well as ‘Thursday’ and ‘Friday’ effects.”
