Dubois Luc, Vogt Kelly, Vinden Chris, Winick-Ng Jennifer, McClure J Andrew, Roshanov Pavel S, Bell Chaim M, Garg Amit X
Departments of Surgery (Dubois, Vogt, Vinden) and of Epidemiology and Biostatistics (Dubois, Vogt, Garg), Schulich School of Medicine and Dentistry, Western University, London, Ont.; Institute for Clinical Evaluative Sciences (Vinden, Winick-Ng, McClure, Bell, Garg), Toronto, Ont.; Lilibeth Caberto Kidney Clinical Research Unit (Roshanov), London Health Sciences Centre, London, Ont.; Department of Clinical Epidemiology and Biostatistics (Roshanov), McMaster University, Hamilton, Ont.; Department of Medicine (Bell), Mount Sinai Hospital, University of Toronto, Ont.
CMAJ. 2017 Feb 27;189(8):E303-E309. doi: 10.1503/cmaj.160511. Epub 2016 Oct 17.
In prior studies, higher mortality was observed among patients who had elective surgery on a Friday rather than earlier in the week. We investigated whether mortality after elective surgery was associated with day of the week of surgery in a Canadian population and whether the association was influenced by surgeon experience and volume.
We conducted a population-based retrospective cohort study in the province of Ontario, Canada. We included adults who underwent 1 of 12 elective daytime surgical procedures from Apr. 1, 2002, to Dec. 31, 2012. The primary outcome was 30-day mortality. We used generalized estimating equations to compare outcomes for surgeries performed on different days of the week, adjusting for patient and surgeon factors.
A total of 402 899 procedures performed by 1691 surgeons met our inclusion criteria. The median length of hospital stay was 6 (interquartile range 5-8) days. Surgeon experience varied significantly by day of week ( < 0.001), with surgeons operating on Fridays having the least experience. Nearly all of the patients who had their procedure on a Friday had postoperative care on the weekend, as compared with 49.1% of those whose surgery was on a Monday ( < 0.001). We found no difference in the 30-day mortality between procedures performed on Fridays and those performed on Mondays (adjusted odds ratio 1.08, 95% confidence interval 0.97-1.21).
Although surgeon experience differed across days of the week, the risk of 30-day mortality after elective surgery was similar regardless of which day of the week the procedure took place.
在先前的研究中，观察到在周五进行择期手术的患者死亡率高于在一周中较早时间进行手术的患者。我们调查了在加拿大人群中，择期手术后的死亡率是否与手术日期相关，以及这种关联是否受外科医生经验和手术量的影响。
我们在加拿大安大略省进行了一项基于人群的回顾性队列研究。纳入了2002年4月1日至2012年12月31日期间接受12种择期日间手术之一的成年人。主要结局是30天死亡率。我们使用广义估计方程比较一周中不同日期进行的手术的结局，并对患者和外科医生因素进行了调整。
1691名外科医生进行的总共402899例手术符合我们的纳入标准。住院时间中位数为6（四分位间距5 - 8）天。外科医生的经验在一周中的不同日期有显著差异（<0.001），周五进行手术的外科医生经验最少。与周一进行手术的患者中49.1%相比，几乎所有在周五进行手术的患者在周末接受术后护理（<0.001）。我们发现周五进行的手术与周一进行的手术在30天死亡率上没有差异（调整后的优势比为1.08，95%置信区间为0.97 - 1.21）。
尽管一周中不同日期外科医生的经验不同，但择期手术后30天死亡率的风险相似，无论手术在一周中的哪一天进行。
