Surgery on Monday ‘could cut hospital deaths’

Alastair Murray said evidence showed fewer deaths occured if risky operations were performed at the start of the week. Picture: Getty

Alastair Murray, a consultant orthopaedic surgeon at Edinburgh’s Royal Hospital for Sick Children, said evidence showed that for risky and complex procedures, death rates were lower if patients were operated on at the start of the week rather than just before the weekend.

But, he warned that waiting-list pressures meant surgeons faced challenges in seeing patients on the best day as managers focused on meeting targets.

Mr Murray, writing in Surgeons’ News, pointed to research earlier this year that found an 80 per cent increased risk of death from planned operations taking place at the weekend compared to on a Monday.

The study also found that the risk of death increased the later in the week that surgery took place, being 44 per cent higher on a Friday than a Monday.

But it found no link between higher deaths and minor operations, such as hip replacements and hernia repairs, being performed on particular days of the week.

Mr Murray said the research provided surgeons with evidence “to make our case for sensible scheduling of risky surgery“.

Speaking to The Scotsman, Mr Murray said surgeons would always try to schedule operations on the best day for patients.

“But we are very constrained by which days of the week we’re given to operate on,” he said.

“Obviously, theatre time is a finite resource and they are trying to allocate that to cover all the specialities and the different demands. Sometimes the day of the week which is best for major surgery isn’t the first consideration and my point was to say that maybe we need to think more like that rather than just think what is the most convenient day in terms of the timetable to operate.”

Mr Murray said for minor surgery, the day of the operation did not seem to matter. But, for procedures such as major abdominal surgery, it was shown to be more of an issue.

While the research did not say why that would be the case, it might be that post-operative care was different at a weekend with less staff available, he said.

But Mr Murray warned surgeons may face problems scheduling operations on the day they thought best due to managers organising surgery around making sure patients did not breach waiting time guarantees.

“With high-volume operations such as hip replacements and other things which are not that risky, hospitals are under huge pressure to get those done,” he said.

“As clinicians we would always want the more risky operations to be given the appropriate priority, even if that is at the cost of having to push waiting-list stuff out the way slightly. If there is extra theatre capacity these days it would normally be given to where the waiting list pressure is greatest.

“That could be a minor list of tonsillectomies. There is always a bit of a push as a clinician to try to make the case for the clinical argument rather than the waiting list pressure argument.”

“The hospital management are getting pushed heavily by the government applying huge pressure to get them to hit waiting list targets or they face financial penalties. But as clinicians we are always desperately keen to prioritise the clinical argument and say this is a big case and it needs to be done on the day we want to do it.”

Ian Ritchie, president of the Royal College of Surgeons of Edinburgh, said the report on safety of surgery according to the day of the week would continue to be debated.

“While we are concerned that there appears to be a variation in safety according to when an operation is done during the week we also recognise that, on the whole, operations done at weekends are more likely to be emergency procedures which, by their very nature, involve greater risk for the patient,” he said.

A Scottish Government spokesman said: “Decisions regarding the scheduling of operations will always be led by clinical rather than administrative need and there is no evidence that this is not currently the case.

“However, we encourage discussions within specialities of all the factors that will determine safe outcomes for patients.”