Surgical Mistakes More Likely for Children Due to “Weekend Effect”

New research suggests that children undergoing an emergency surgery on a weekend may face a greater risk of suffering severe complications, including death. 

Even routine surgeries that are considered simple and relatively safe, such as an appendix removal or hernia repair, may carry increased risks when they are performed on an emergency-basis over a weekend, as opposed to standard procedures scheduled for a normal workday.

In a study published in the July issue of the Journal of Pediatric Surgery, researchers from the Johns Hopkins Children’s Center called this phenomenon the “weekend effect.”

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Children undergoing procedures on the weekend may be 63% more likely to die than those treated during the week. In addition, these children may be 40 percent more likely to develop complications, according to the findings.

Many of the complications included surgical errors, such as inadvertent wound lacerations or punctures. Researchers speculate this may be due to clinician error or equipment malfunction during or after surgery.

Researchers examined 22 years of surgical records involving 440,000 pediatric admissions nationwide. Of the nearly half a million patients, 112,000 were treated on the weekends.

“The marked difference in death and risk of other complications points to a worrisome ‘weekend effect’ observed across hospitals nationwide that calls for an in-depth examination of possible after-hours safety lapses and clinical glitches,” wrote study authors.

Overall, the risk of dying was small. Deaths attributable to the “weekend effect” were 30 over the course of the 22 year study period. Yet the study results showed weekend patients had a higher risk of dying.

Weekend patients were also 14 percent more likely to need blood transfusions. However, Dr. Fizan Abdullah, lead author and pediatric surgeon the Johns Hopkins Children’s Center said weekend patients were no more likely to need blood transfusions or suffer serious blood loss during surgery than weekday patients.

“Numerically speaking, the number of deaths was quite small, but even a single preventable death is one too many. This demands that we examine any factors that may cause or contribute to such occurrences and find ways to prevent them,” said Abdullah.

The surgeries studied, including drainage of infected wounds, bone fracture treatments, and draining excess fluid in the brain; were all considered relatively safe and routine surgeries.

In fact, weekend surgeries were no more severe than cases which were seen during the week. A point researchers say reveals the condition of a patient was not a factor in increased risk of complication or death.

Researchers say factors which may contribute to the “weekend effect” include decreased staffing, slower response times, decreased availability of certain imaging and lab tests and how soon those tests were done.

Also overcrowding of the emergency room, how many people were in the operating room or how many nurses were on a specific unit may also play a role in increasing the risk.

However, they emphasize more research is needed to determine exactly what the cause for the increased risk may be.

In 2010, a study conducted at several university medical schools across the country found patients admitted to a hospital’s intensive care unit (ICU) over the weekend were more likely to die than patients admitted during the week.

Patients admitted to the ICU during the weekend had an eight percent increased risk of death. The findings of the older study seemed to also point to the “weekend effect” in ICU patients as well.


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