Bleeding Risk for Elective Cardiac Surgery Lower on Weekends

Pavankumar Kamat

February 01, 2022

A new study, published in the  European Journal of Cardio-Thoracic Surgery , found no differences in key postoperative outcomes among patients undergoing an elective cardiac surgery on any day of the week, with the exception of return to theatre for bleeding risk, which was lower on weekends.

Many studies in the past have highlighted a higher risk of mortality for weekend admissions. The likelihood of weekday variation on clinical outcomes has also been explored in patients undergoing surgery. However, the evidence so far has been conflicting.

The authors stated: "To our knowledge, this is the largest analysis examining the outcomes of cardiac surgery by day of the week and is reflective of real-world practice."

Study Details

Researchers at the Bristol Heart Institute, University of Bristol, used the National Adult Cardiac Surgery Audit registry to identify and retrospectively analyse data on operations performed between February 1996 and March 2019. Elective operations included aortic valve replacement (AVR), coronary artery bypass grafting (CABG), mitral valve repair or replacement (MVR) and combined procedures (CABG plus valve surgery).

Key outcomes assessed were 30-day mortality, stroke, postoperative dialysis requirement and return to theatre for bleeding. Adjustments were made for the relevant European System for Cardiac Operative Risk Evaluation (EuroSCORE) II covariates.

A total of 371,500 patients who had elective cardiac surgery were included in the analysis. Of these, 16.3% had AVR, 9.8% had AVR plus CABG, 64.3% had isolated CABG, 7.1% had isolated MVR and 2.4% had MVR plus CABG. The proportion of operations over the weekend was only 3%.

The findings showed no significant effect of the day of the week on major outcomes of surgery, including 30-day mortality (P=0.081), stroke (P=0.137) and postoperative dialysis requirement (P=0.732). However, the likelihood of return to theatre for bleeding or tamponade (P= 0.039) for all procedures was significantly lower over the weekend.

CABG being the most common adult cardiac operation, a subgroup analysis of patients undergoing isolated CABG was performed. The analysis showed no variation in any outcomes by the day of the week.

Plausible Explanations

The authors present several plausible explanations for the findings. The presence of dedicated surgical teams for weekend elective operations in the UK and cardiac surgery consultant contracts averaging just two operating days a week could mean lesser surgeon fatigue towards the end of the week.

The lower risk of return to theatre for bleeding over the weekend could be attributed to an increased awareness about this complication among surgeons.

The research received no funding. The authors reported no conflict of interests.

Fudulu DP, Dimagli A, Sinha S, Narayan P, Chan J, Dong T, Benedetto U, Angelini GD. Weekday and outcomes of elective cardiac surgery in the UK: a large retrospective database analysis. Eur J Cardiothorac Surg. 2022 Jan 29 [Epub ahead of print]. doi: 10.1093/ejcts/ezac038. PMID: 35092280.



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