1. 1,600 People In UK Die Annually Because They Have Surgery on Fridays
and Recover With Reduced Staff
From Today's London Times -
Chris Smyth Health Correspondent
Last updated at 12:01AM, May 29 2013
Patients who have operations on a Friday are almost 50 per cent more likely to die than those who go under
the knife on a Monday, a study has found. About 1,600 patients a year die needlessly because surgery
becomes steadily more dangerous throughout the working week, the analysis suggests.
While previous studies have found that patients admitted at the weekend are more likely to die, the latest
study is the first to find a similar effect during the week. The authors of the report said the root causes
were likely to be the same, with patients undergoing surgery on Fridays forced to recuperate over the
weekend when senior doctors are often unavailable, nursing staff are fewer and testing services are reduced.
The findings will place pressure on NHS bosses to intensify their efforts to offer a fuller range of hospital
services seven days a week. “If I were a patient being operated on on Friday, I would want to know that
there were adequate services available at the weekend to be able to pick up any potential problems,” said
Paul Aylin, the assistant director of the Dr Foster unit at Imperial College London, who led the study. “Our
hypothesis was that there is a period of time immediately following operations, the first 48 hours, which is
the critical time when things can go wrong. You get bleeds, or the beginnings of an infection ... and the
closer you get to the end of the week, the more that post-operative period overlaps with the weekend
services and therefore the potential for some of these complications being less well picked up. “I think it’s
not just lack of senior experienced staff — in general we’re talking about fewer nursing staff, fewer
diagnostic services; if you can’t order an X-ray or a blood test, that will have an impact.”
Dr Aylin’s team looked at more than four million operations across England, ranging from hip
replacements to heart bypasses. On Mondays, there were 5.5 deaths per 1,000 operations, but this climbed
to 8.2 per 1,000 on a Friday, they report in the British Medical Journal. After adjusting for different types
of procedures, and the ages and illnesses of patients, deaths were 44 per cent more likely on a Friday than a
Monday. Planned operations at the weekend were 82 per cent more likely to be fatal.
Antony Narula, a member of the council of the Royal College of Surgeons, said: “It is not acceptable that
there should be such a wide variation in the mortality rates following elective surgery, according to the day
of the week the operation takes place. It has long been recognized that the 48-hour period after surgery is
critical to a patient’s chances of recovery and today’s study rightly suggests that this is an area which needs
further research.” Professor Narula added: “This reinforces ... the need for full clinical support being
available seven days a week in hospital.”
Professor Sir Bruce Keogh, medical director of NHS England, has said he wants hospitals to look at
operating a normal service at weekends. But some leading doctors say the cash-strapped NHS has more
urgent priorities.
Sir Bruce said yesterday: “NHS England is committed to providing safe care for all patients, regardless of
when they receive their treatment.We have established a forum to develop viable financial and clinical
options to help our NHS provide more comprehensive services seven days a week. This forum will report
back in the autumn.”