Time of Day and Day of Week for Elective Surgeries

A few months ago, I had written about the “time of day” issue when consulting physicians and doctors.  The later you see a physician in their shift, the higher is the chance that the interaction will leave you dissatisfied and/or the outcome may be poorer than when you are the first or second patient during that doctor’s shift.

The same thing should logically apply to surgeries. It stands to reason that surgeries performed during regular working hours would have fewer complications and better outcomes than those performed later in the evening or at night or over weekends.

Anyone who has been admitted to a hospital knows there is a natural ebb and flow of staff and therefore, the care available, depending on the time of day and the day of the week. At night and on weekends, especially the second half of Saturday and on Sundays in India, the staff is less, often more inexperienced and senior consultants are rarely available.

However, the data to support poorer outcomes because of these issues has been conflicting. Some studies have shown a difference and some have shown none.

A recent study from Sweden headed by Maximilian Peter Forrsten and colleagues [1] looked at 130,407 hip fracture patients between 2008 and 2017, 2/3^rd of whom were operated during regular hours and 1/3^rd out-of-hours. They found a clear difference in 30 and 90 days mortality in those who underwent arthroplasties (hip replacements).  Unlike physician fatigue, which drives poorer outcomes during consultations, the poorer surgical outcomes were more likely due to the lack of adequate / experienced staff available “out-of-hours” to deal with complications following complex surgeries like arthroplasties.

Another study from Scotland headed by Luke Farrow and colleagues [2] looked at 15,351 admissions for hip fractures between 2014 and 2018 and found that patients admitted on Thursdays or Fridays received a lower quality of care. This was likely due to the limited availability of staff such as physiotherapists and occupational therapists needed for post-surgical care.  In India, this would translate to doing surgeries on Saturdays or the second half of Fridays, since most doctors and paramedical staff will work on Saturdays, but rarely on Sundays.

How does this affect you? Unless the surgery is a dire emergency, in all elective situations, it is best to get operated during regular working hours, preferably between Monday and Thursday or the first half of Friday.

Footnotes

1. Forssten MP, Mohammad Ismail A, Borg T, Cao Y, Wretenberg P, Bass GA, Mohseni S. The consequences of out-of-hours hip fracture surgery: insights from a retrospective nationwide study. Eur J Trauma Emerg Surg. 2021 Oct 7. doi: 10.1007/s00068-021-01804-y. Epub ahead of print. PMID: 34622327.

2. Farrow L, Hall A, Aucott L, Holt G, Myint PK. Does quality of care in hip fracture vary by day of admission? Arch Osteoporos. 2020 Mar 20;15(1):52. doi: 10.1007/s11657-020-00725-4. PMID: 32198579; PMCID: PMC7083802.

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