Death more likely after a weekend operation: Weekly dip in recovery rates worldwide proves need for a ‘seven-day NHS

Global study involving 55m patients reveals deaths significantly more likely following Saturday surgery

Sick? In need of an operation? Then keep your fingers crossed that your consultant doesn’t schedule your procedure for a weekend afternoon – especially one in February. Patients are up to 17 per cent more likely to die if they are admitted at the weekend, an unprecedented global study has revealed.

As the NHS prepares to enter an era of seven-day working, data from 72 different research projects covering more than 55 million patients found that the “weekend effect” is international. Researchers from Tohoku University, Japan, who analysed worldwide hospital death rates, said the most likely explanation for the results was poorer quality care at weekends.

Their findings, to be presented today at a meeting of leading European anaesthesia specialists in Stockholm, are supported by another study which discovered similar concerns about mortality levels at Berlin’s hospitals. Researchers at the Charité medical school found death rates can be affected by not only the day of the week, but the time of year and even whether surgery is carried out in the morning or the afternoon. The findings, based on an analysis of nearly 220,000 patients treated at two of the university’s hospitals between 2006 and 2011, show that mortality was higher in the afternoons, at weekends, and peaked in February.

Dr Felix Kork of Charité said the precise causes are unknown. “It is speculation, but in the afternoon it may be that the surgeries are more likely to be urgent than in the morning, although we tried to control for that factor. It may also be that the human immune system reacts differently at different times of the day, but there is not a lot of data supporting that theory. February is usually a time when many people are ill due to viral infections – that may have an influence on the outcomes.”

He also suggested that seasonal hormonal rhythms, for instance of the “sleep hormone” melatonin, might be affecting the performance of staff and surgical responses of patients in February, but said this theory was “speculative”.

NHS England has already acknowledged that hospital care suffers at the weekends, and plans are in train to ensure more senior doctors are available to prevent problems and complications escalating into life-threatening situations. Plans for a “seven-day NHS” are also in place in Scotland and Wales.

Last year, a study in the British Medical Journal provided evidence to support long-standing fears that surgery in the NHS was more dangerous at the weekend. The study, led by Dr Paul Aylin of the Dr Foster Unit, the Imperial College research team which has pioneered the publication of hospitals’ surgical outcomes data, revealed that patients who had an operation on Friday or Saturday were 44 per cent or 82 per cent more likely to die within 30 days than those who had surgery on a Monday.

It also showed the risks of surgery became progressively higher from Monday to Saturday, although only 4.5 per cent of elective procedures are carried out at weekends, and the average mortality risk for such procedures is low – 0.67 per cent. Evidence has also shown patients admitted to NHS hospitals at the weekend, not necessarily for surgery, also have a higher mortality risk.

Commenting on the new studies, Dr Aylin said they added up to “powerful” evidence of a global problem in healthcare. “The German study is interesting in raising afternoon surgery as an issue, but as the authors acknowledge, it may be that ‘the patients treated in the afternoon and on the weekends were more severely ill’,” he said.

“The Japanese study is powerful in that it combines the results of 72 studies from around the world …. Both studies acknowledge the differences could reflect poorer care or simply that patients admitted at these times were more severely ill. More research is needed to find out exactly what contributes to higher mortality at weekends. Is it lack of clinical staff, nursing staff, diagnostic services, other hospital resources?”

NHS England has decided that the numbers and degree of seniority of staff at weekends is to blame. Reforms announced by NHS England’s medical director, Sir Bruce Keogh, at the end of last year could see more consultants, and many other NHS staff, made available at weekends. However, the plans could cost between £1bn and £2bn, and many in the health service have raised concerns that this may be unaffordable, given the huge financial pressure already faced by NHS trusts.

PROMOTED VIDEO
Life and Style
ebookNow available in paperback
ebooks
ebookPart of The Independent’s new eBook series The Great Composers
News
Tangerine Dream Edgar Froese
people
News
Rob Lowe
peopleRob Lowe hits out at Obama's snub of Benjamin Netanyahu
News
Davies (let) says: 'Everybody thought we were having an affair. It was never true!'
people'Our friendship flourished online. You can share some very revelatory moments at four in the morning…'
Arts and Entertainment
Over their 20 years, the band has built a community of dedicated followers the world over
music
News
Staff assemble outside the old City Road offices in London
mediaThe stories, the writers and the changes over the last quarter of a century at Britain's youngest paper
Life and Style
The Oliver twins, Philip and Andrew, at work creating the 'Dizzy' arcade-adventure games in 1988
techDocumentary looks back at origins of the computer-games industry
Arts and Entertainment
Krall says: 'My hero player-singer is Elton John I used to listen to him as a child, every single record
music
News
Friends for life … some professionals think loneliness is more worrying than obesity
scienceSocial contact is good for our sense of wellbeing - but it's a myth that loneliness kills, say researchers
Arts and Entertainment
The Wu-Tang Clan will sell only one copy of their album Once Upon A Time In Shaolin
musicWu-Tang Clan and The Sexual Objects offer fans a chance to own only copies of their latest albums
News
i100
Environment
Number so freshwater mussels in Cumbria have plummeted from up to three million in the 20th century to 500,000
environment
Latest stories from i100
Have you tried new the Independent Digital Edition apps?

ES Rentals

    Independent Dating
    and  

    By clicking 'Search' you
    are agreeing to our
    Terms of Use.

    iJobs Job Widget
    iJobs General

    Austen Lloyd: Private Client Solicitor - Oxford

    Excellent Salary : Austen Lloyd: OXFORD - REGIONAL FIRM - An excellent opportu...

    Austen Lloyd: Clinical Negligence Associate / Partner - Bristol

    Super Package: Austen Lloyd: BRISTOL - SENIOR CLINICAL NEGLIGENCE - An outstan...

    Recruitment Genius: Sales Consultant - Solar Energy - OTE £50,000

    £15000 - £50000 per annum: Recruitment Genius: Fantastic opportunities are ava...

    Recruitment Genius: Compute Engineer

    Negotiable: Recruitment Genius: A Compute Engineer is required to join a globa...

    Day In a Page

    Iraq invasion 2003: The bloody warnings six wise men gave to Tony Blair as he prepared to launch poorly planned campaign

    What the six wise men told Tony Blair

    Months before the invasion of Iraq in 2003, experts sought to warn the PM about his plans. Here, four of them recall that day
    25 years of The Independent on Sunday: The stories, the writers and the changes over the last quarter of a century

    25 years of The Independent on Sunday

    The stories, the writers and the changes over the last quarter of a century
    Homeless Veterans appeal: 'Really caring is a dangerous emotion in this kind of work'

    Homeless Veterans appeal

    As head of The Soldiers' Charity, Martin Rutledge has to temper compassion with realism. He tells Chris Green how his Army career prepared him
    Wu-Tang Clan and The Sexual Objects offer fans a chance to own the only copies of their latest albums

    Smash hit go under the hammer

    It's nice to pick up a new record once in a while, but the purchasers of two latest releases can go a step further - by buying the only copy
    Geeks who rocked the world: Documentary looks back at origins of the computer-games industry

    The geeks who rocked the world

    A new documentary looks back at origins of the computer-games industry
    Belle & Sebastian interview: Stuart Murdoch reveals how the band is taking a new direction

    Belle & Sebastian is taking a new direction

    Twenty years ago, Belle & Sebastian was a fey indie band from Glasgow. It still is – except today, as prime mover Stuart Murdoch admits, it has a global cult following, from Hollywood to South Korea
    America: Land of the free, home of the political dynasty

    America: Land of the free, home of the political dynasty

    These days in the US things are pretty much stuck where they are, both in politics and society at large, says Rupert Cornwell
    A graphic history of US civil rights – in comic book form

    A graphic history of US civil rights – in comic book form

    A veteran of the Fifties campaigns is inspiring a new generation of activists
    Winston Churchill: the enigma of a British hero

    Winston Churchill: the enigma of a British hero

    A C Benson called him 'a horrid little fellow', George Orwell would have shot him, but what a giant he seems now, says DJ Taylor
    Growing mussels: Precious freshwater shellfish are thriving in a unique green project

    Growing mussels

    Precious freshwater shellfish are thriving in a unique green project
    Diana Krall: The jazz singer on being friends with Elton John, outer space and skiing in Dubai

    Diana Krall interview

    The jazz singer on being friends with Elton John, outer space and skiing in Dubai
    Pinstriped for action: A glimpse of what the very rich man will be wearing this winter

    Pinstriped for action

    A glimpse of what the very rich man will be wearing this winter
    Russell T Davies & Ben Cook: 'Our friendship flourished online. You can share some very revelatory moments at four in the morning…'

    Russell T Davies & Ben Cook: How we met

    'Our friendship flourished online. You can share some very revelatory moments at four in the morning…'
    Bill Granger recipes: Our chef serves up his favourite Japanese dishes

    Bill Granger's Japanese recipes

    Stock up on mirin, soy and miso and you have the makings of everyday Japanese cuisine
    Michael Calvin: How we need more Eric Cantonas to knock some sense into us

    Michael Calvin's Last Word

    How we need more Eric Cantonas to knock some sense into us