Mortality After Nonemergent Major Surgery Performed on Friday Versus Monday Through Wednesday.
Zare, Marc M. MD *+; Itani, Kamal M. F. MD *+; Schifftner, Tracy L. MS ++; Henderson, William G. PhD ++; Khuri, Shukri F. MD *[S]
Annals of Surgery.
246(5):866-874, November 2007.
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Objective: To determine whether nonemergent major surgery leads to higher mortality when performed on Friday versus early weekdays.
Summary Background Data: Adults admitted emergently to acute-care hospitals on weekends experience higher mortality than those admitted on weekdays.
Methods: Cohort study of 188,212 patients undergoing nonemergent major surgery at 124 Veterans Affairs hospitals from 2000 to 2004. Risk-adjusted 30-day mortality was compared for operations performed on Fridays versus Mondays through Wednesdays. Data were derived from the Veterans Affairs' National Surgical Quality Improvement Program database. Patients were divided into 3 groups: floor (admitted postoperatively to regular floor), ICU (admitted postoperatively to intensive care unit), and outpatient (not admitted postoperatively). A stepwise logistic regression analysis was used to test the effect of day of surgery (Friday vs. Monday-through-Wednesday) on 30-day mortality in the presence of characteristics that were significant in bivariate analysis.
Results: In the floor group (n = 89,786), operations performed on Fridays were associated with a higher 30-day mortality rate than those performed on Mondays through Wednesdays (2.94% vs. 2.18%; odds ratio, 1.36; 95% confidence interval, 1.24-1.49; P < 0.001). After adjusting for patient characteristics, odds ratio of 30-day mortality for operations on Fridays, when compared with Mondays through Wednesdays, was 1.17 (95% confidence interval, 1.05-1.26; P = 0.003). Within the ICU (n = 14,271) and outpatient (n = 84,155) groups, nonsignificant differences in 30-day mortality were observed for operations on Fridays versus Mondays through Wednesdays.
Conclusions: For patients admitted to regular hospital floors after nonemergent major surgery, mortality is increased if surgery is performed on Friday versus Monday through Wednesday.
(C) 2007 Lippincott Williams & Wilkins, Inc.