The surgery scheduling lottery

4 June 2013

Research published in the British Medical Journal on 23 May 2013 finds that patients who have elective surgery later in the week face a higher risk of death.

The study looked at data gathered over three years (2008-2011) from over 4 million inpatient surgical procedures. It looked at high risk procedures, such as excision of the oesophagus, stomach, colon or rectum and coronary by-passes and low risk procedures such as hip and knee replacements and hernia repairs. Of the patients studied, nearly 28,000 died within 30 days of surgery.

Mondays are the safest day to have elective surgery, the risk of mortality for surgery taking place on a Friday increases by 44% for high risk surgical procedures, and 33% for low risk surgical procedures. 

Serious complications of surgery are likely to arise in the first 48 hours. If surgery takes place on a Thursday or Friday then this means patients are reliant on weekend healthcare staff to spot and address and problems. Experts have previously suggested that the increase in mortality for those treated at weekends might be due to the staff on duty being less experienced, or the facilities or services available in the week for identifying and treating problems being unavailable.

Widely reported research has previously found that there is a significantly higher death rate for patients admitted as an emergency at the weekend, rather than during the week. A 2009 study by Imperial Healthcare London found that death rates were 6% higher on Black Wednesday, the first Wednesday in August that newly qualified medical graduates take up their first posts. It would therefore seem that poor care or provision is the primary reason for the increase in mortality.

We echo the report’s conclusion that as the NHS moves towards greater efficiency, it is essential to ensure that adequate services are provided to support patients on every day of the week to achieve the best possible outcome and avoid patients suffering unnecessarily.

If you are concerned about the care you or someone close to you has received please contact our lawyers on 020 7814 1200 or by email at

BMJ: Day of week of procedure and 30 day mortality for elective surgery: retrospective analysis of hospital episode statistics

Plosone: Early In-Hospital Mortality following Trainee Doctors' First Day at Work

BMJ: Weekend mortality for emergency admissions. A large, multicentre study

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