The research highlighted several significant disparities in patient outcomes based on the day of surgery.
Published Mar 07, 2025 | 1:17 PM ⚊ Updated Mar 07, 2025 | 1:17 PM
Representative photo of a surgery being performed
Synopsis: A comprehensive study of nearly half a million patients has found that those who undergo surgery just before the weekend face higher risks of complications, hospital readmissions, and even mortality compared to those who have their procedures after the weekend.
You have an elective surgery planned, and scheduling it on a Friday seems convenient—it saves time, minimizes work leave, and allows for weekend recovery. But new research suggests it may not be the best idea.
A comprehensive study of nearly half a million patients by researchers from Houston Methodist Hospital, UCLA, the University of Toronto, and other institutions has found that patients who undergo surgery just before the weekend face higher risks of complications, hospital readmissions, and even mortality compared to those who have their procedures after the weekend.
Published in JAMA Network Open, the study examined medical records from 429,691 adults who underwent one of 25 common surgical procedures in Ontario, Canada, between 2007 and 2019.
The research team divided patients into two groups: those who had surgery one day before the weekend (Friday or pre-holiday) and those who had surgery one day after (Monday or post-holiday). They then analyzed short-term (30-day), intermediate-term (90-day), and long-term (one-year) outcomes, including mortality, readmission rates, complications, hospital length of stay, and duration of surgery.
The research highlighted several significant disparities in patient outcomes based on the day of surgery.
Higher mortality rates: Patients undergoing Friday surgeries had a 9 percent higher risk of death within 30 days, 10 percent higher mortality at 90 days, and a 12 percent higher risk at one year compared to those who had surgery after the weekend.
Increased complications and readmissions: The combined risk of death, complications, and readmissions within 30 days was 5 percent higher for pre-weekend surgeries.
Longer hospital stays: Patients who had Friday surgeries tended to remain in the hospital longer than their Monday counterparts, likely due to limited discharge planning or complications requiring extended care.
Elective vs. emergency procedures: Interestingly, while elective procedures performed before the weekend had worse postoperative outcomes, urgent or unplanned surgeries conducted before the weekend showed slightly better outcomes. This suggests that hospital systems may be better equipped to handle emergencies than routine procedures over the weekend.
The “weekend effect” is a well-documented phenomenon in healthcare, describing worse patient outcomes linked to medical care provided over weekends. This trend has been observed in emergency medicine, stroke care, and now, elective and emergency surgeries. The reasons behind the weekend effect may be multifaceted, including:
Reduced staffing: Many hospitals have fewer surgeons, specialists, nurses, and support staff available over the weekend, which may delay post-operative care and responses to complications.
Limited resources: Ancillary services such as diagnostic imaging, laboratory testing, and rehabilitation services may operate at reduced capacity on weekends, potentially delaying critical care decisions.
Surgeon experience and scheduling: The study found that surgeons performing Friday surgeries were slightly younger, with a median age of 47 years, compared to 48 years for Monday surgeries. Additionally, Monday surgeons had an average of 17 years of experience, compared to 14 years for Friday surgeons, potentially influencing patient outcomes.
While the study focused on hospitals in Ontario, similar findings have been reported in other countries. Studies in the UK and Australia have also identified increased mortality and complication rates for patients admitted over weekends, suggesting that this is not just a regional issue but a systemic challenge within healthcare worldwide.
The common denominator appears to be the structural and staffing issues that arise when hospitals operate at reduced capacity over weekends.
One of the more controversial yet unavoidable aspects of this discussion is the potential role of surgeon fatigue. Some critics argue that medical professionals, like individuals in other fields, may experience cognitive fatigue as they near the end of the workweek. While the study does not directly link surgeon exhaustion to adverse patient outcomes, it remains a question worth investigating further.
The idea of the “Friday effect” extends beyond healthcare. In the automotive industry, for example, there has long been a belief that cars assembled on Fridays are more prone to defects due to distracted or fatigued workers eager for the weekend.
While the comparison may seem anecdotal, it raises broader questions about human performance variability throughout the week and how it might influence outcomes in high-stakes professions like surgery.
(Edited by Sumavarsha).
