No Increase in Complications from Surgery on Weekends

MedicalResearch.com Interview with:
Mr. Aneel Bhangu
West Midlands Research Collaborative,
Academic Department of Surgery
Queen Elizabeth Hospital
Birmingham UK

MedicalResearch.com: What are the main findings of the study? 

Mr. Bhangu:  Out study was based on a novel collaborative approach, spanning 95 centres in the UK. It was led by surgical trainees, who form a natural network and work in a rotational pattern. These networks will mature to allow a future of clinical research to be embedded into routine NHS care.

Our study found no increase in complications based on weekend operating. It’s possible that patients present differently at weekends, or that surgeons select less complex patients to operate upon. A key secondary finding is that patients operated on at weekends were less likely to undergo laparoscopy. This means that they are exposed to different processes of care, which may introduce risk. This may be a surrogate marker for other differences in weekend care that require exploration.


MedicalResearch.com: Were any of the findings unexpected?

Mr. Bhangu: Patients operated on Sundays were less likely to have complex appendicitis. This suggests that selection is toward simple cases, which helps explain why weekend operating is safe in its current form.

MedicalResearch.com: What should clinicians and patients take away from your report?

Mr. Bhangu:  Patients should be reassured that current practice is safe. This study covered over 90 hospitals, meaning it reflects a wide range of modern centres. Clinicians should use it as a benchmark to reflect on their own practice. In particular, they should analyse their own systems to check that care processes at weekends do not place patients at risk.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Mr. Bhangu: This study illustrates the need for a research approach based on health informatics blended with randomised clinical trials. Processes associated with best care should be identified from large datasets, and characteristics of best performing centres should be sought. This is best achieved through clinicians interacting with large datasets and performing clinically relevant, sophisticated analyses. A shift away from ranking hospitals and identifying outliers is needed, with a culture moving towards identifying best care processes relevant to all centres.

Such an approach should lead to hypotheses and findings that power randomised controlled trials. Additionally, these trials should take their follow-up from large, routinely collected datasets, to minimise costs. This blend of surgical health informatics and randomised, multicentre clinical trials represents the next evolution of cost-effective, large-scale, patient-relevant research.

Citation:

A multicentre cohort study assessing day of week effect and outcome from emergency appendicectomy

Henry JM Ferguson, Nigel J Hall, Aneel Bhangu, on behalf of the National Surgical Research Collaborative

BMJ Qual Saf bmjqs-2013-002290Published Online First: 7 February 2014 doi:10.1136/bmjqs-2013-002290