No weak days? Impact of day in the week on surgical mortality.

BACKGROUND: Studies show increased rates of mortality for admissions on the weekend (WE) versus the weekday (WD). However, scepticism exists of this so-called 'weekend effect' on patient outcome. It remains poorly investigated, particularly the timing of the day of surgery and post-operative outcomes. A UK study found higher odds of death when operated on Friday and the WE, versus WD. This relationship was investigated by interrogating the Australian and New Zealand Audit of Surgical Mortality database. METHODS: A standardized tool is used to collect data after every surgical death. Data in this retrospective cohort study from participating private and public hospitals in Australia on elective and emergency operations were extracted and included 7718 patients who had a surgical procedure within 30 days of admission and who subsequently died. A proxy measure of early surgical mortality, namely odds of dying within the first 48 h following surgery, was used to compare surgical mortality across days of the week. RESULTS: Unadjusted and adjusted odds of early surgical mortality were higher on the WE compared to WD, unadjusted and adjusted OR 1.30 (P < 0.001) and 1.19 (P = 0.026), respectively. When separated by day of week, there was a trend for higher surgical mortality on Friday, Saturday and Sunday versus all other days, although this did not reach statistical significance. ASA grade and specialty of surgery were important predictors of outcome. CONCLUSION: There appears to be an association between day of surgery and surgical outcome. The exact cause and contributing factors requires further investigation.

Australian and New Zealand Audit of Surgical Mortality: concordance between reported and audited clinical events and delays in management in surgical mortality patients.

BACKGROUND: The Australian and New Zealand Audit of Surgical Mortality (ANZASM) is a nationwide confidential peer review of deaths associated with surgical care. This study assesses the concordance between treating surgeons and peer reviewers in reporting clinical events and delays in management. METHODS: This is a retrospective cross-sectional analysis of deaths in 2009 and 2010. Cases that went through the process of submission of details by the surgeon in a structured surgical case form (SCF), first-line assessment (FLA) and a more detailed second-line assessment (SLA) were included. Significant clinical events reported for these patients were categorized and analysed for concordance. RESULTS: Of the 11,303 notifications of death to the ANZASM, 6507 (57.6%) were audited and 685 (10.5%) required the entire review process. Nationally, the most significant events were post-operative complications, poor preoperative assessment and delay to surgery or diagnosis. The SCF submissions reported 338 events, as compared with 1009 and 985 events reported through FLA and SLA, respectively (P = 0.01). Treating surgeons and assessors attributed 29-30% of events to factors outside the surgeon's control. Surgeons felt that delay to surgery or diagnosis was a significant event in 6.6% of cases, in contrast to 20% by assessors (P = 0.01). Preoperative management could be improved in 19% of cases according to surgeons, compared with 45 and 36% according to the assessors (P < 0.001). CONCLUSION: There is significant discordance between treating surgeons and assessors. This suggests the need for in-depth analysis and possible refinement of the audit process.