A “weekend effect” in the success of surgery? This question is the starting point for a study published in early March in Jama Network Open, a serious scientific journal. In this publication, Canadian researchers have analyzed data of 429,691 adult patients from Ontario (Canada), who have undergone a current “current” surgery Between January 1, 2007 and December 31, 2019.
Among the operated before the weekend, mainly on Friday, and the operated just after, on Monday, there is a notable gap in the soft operation of the attention route.
“The results suggest that patients treated before the weekend face a greater risk of complications,” conclude the authors of this study.
There is a “statistically significant increase” of deaths, complications and re -enters. A strange “weekend effect”, which is recorded in the groove of other articles, such as those published in scientific journals Open BMJ in 2013 or Medical attention In 2017.
“Modest but real differences”
Can we assume that your conclusions are also true in France? Experts requested by BFMTV.com Activecent. “This Canadian study is of good value. It highlights the differences without a doubt (among the people operated before the weekend and the others, note), but real differences,” explains Hubert Johanet, general secretary of the National Academy of Surgery. “These results confirm other studies and their conclusions are applicable to France.”
Observation is performed: being operated on Friday could lead, with a relatively low probability, to complications. There is still an even more interesting question: why? At this point, if the authors of the study raised an observation, they could not generate a clear response.
“In general, what we can say is that, as in any sector, it is obvious that at the end of the week and in particular at the end of Friday, they are the same teams that are tired, with a week of the leg operating room,” says Philippe Cuq, president of the Union of Surgeons in France.
A point to put things in perspective. The same surgeon is not a scalpel from Monday morning until Friday night. Actually, several teams of surgeons, anesthetists, nurses turn. And these professionals remember that part of their training requires being able to operate at the high foot, at all hours and night, without the quality of care. Of course, all inextricable human weaknesses.
One of the elements presented in this study is the experience of surgeons operating at the end of the week: 14 years of practice on average against 17 for those who occupy the block at the end of the week. However, with this type of CV, not enough to talk about junior doctors.
“Naturally, the surgeons with the greatest occupy the holidays instead, at the beginning of the week (…) On Friday, it is rather the young people who arrive, I could observe it operating for 25 years in the Chu in Paris and in the private one,” the member of the Surgery Academy diagram.
“We will see this on Monday”: small delays and big problems
“Naturally”, surgeons tend to avoid programming interventions on Friday. So that? Because the workforce present the weekend is different, and operating methods as well.
The week, in case of a problem, you can consult the responsible surgeon. On Saturday and Sunday, in case of a big problem, we resort to a current surgeon or an anesthesiologist, not necessarily the head of the case. “And if there are less important decisions, we can govern and say: we will see it on Monday,” says Hubert Johanet.
Accumulated, these small management delays can lead to complications. “If for 98% of patients, there is no problem, there are 2% where to have waited can be harmful,” he said.
Another bias is emerging. If professionals tend to avoid operations on these dates, those who are still in billiards are those for whom it is simply not possible to wait. More urgent and more complex cases.
“It always jokes, in August, France is on vacation,” compares the vascular surgeon Philippe Cuq. “When you are operated (that month), it is not that I cannot wait. Therefore, you can also imagine that Friday are things that you cannot expect.”
Much of “so”, “perhaps” and quite little concrete. But the simple observation of a harmful “weekend effect” nourishes all constant reflection on patient care. “The problem is not important. But you must ask yourself why this difference exists and, above all, how to deal with the causes in each establishment, in each team,” concludes Hubert Johanet.
Source: BFM TV
