Study debunks idea of ‘weekend effect’ after major cardiac surgery

Despite the myth of a “weekend effect” in cardiac surgery—the idea that patients discharged from the hospital on weekends and holidays face higher readmission rates—a team of University of California, Los Angeles researchers concluded this month that heart patients face a similar risk of readmission regardless of the day of week they’re discharged.

The study, published in the Annals of Thoracic Surgery Oct. 11, evaluated data from 4,877 patients discharged from non-emergency heart operations at the Ronald Reagan UCLA Medical Center between 2008 and 2016. Of those patients, nearly one-fifth were discharged on a weekend or holiday.

Author Peyman Benharash, MD, and colleagues said rates of rehospitalization after major cardiac surgeries have been reported up to 22 percent—something that, in past research, has been attributed in part to the weekend effect. The concept was introduced in 2014, after British health secretary Jeremy Hunt announced U.K. hospitals could avoid at least 6,000 more deaths a year if they were more readily staffed on Saturdays and Sundays.

“The weekend effect phenomenon, which has been used to describe higher morality in MI, stroke and cardiac arrest admissions that occur on the weekend or at night, has been attributed to lower staffing levels and higher physician turnover on off-hours,” Benharash and colleagues wrote. “Given the strong correlation between weekend admissions and outcomes after common conditions, we aimed to investigate whether such differences in staffing from the usual weekday routine would affect the discharge process for cardiac surgical patients.”

Though almost 20 percent of the patient pool was discharged on a weekend or holiday, readmission rates for weekday and weekend discharges were comparable: 11.4 percent compared to 10.9 percent, respectively. 

More patients were discharged to facilities on weekdays than on weekends, the authors said—15 percent compared to 5.7 percent. Discharge to a facility was also associated with a higher all-cause, unadjusted remission rate, which hit 16.7 percent in patients discharged during the week and 12.7 percent in patients discharged on weekends or holidays.

After adjusting for patient comorbidities, operative performance and postoperative complications, the team’s results remained solid.

“We were surprised to find that patients discharged on weekends and holidays had similar readmission rates and outcomes as patients who were cleared on weekdays,” Benharash said in a release. “Prior planning was likely a critical aspect of successful weekend and holiday discharges at our institution.”

He said in 2010, UCLA launched a Readmission Reduction Program aimed at smoothing out the wrinkles in their hospital’s discharge process. Heart patients now receive earlier education and “discharge kits” containing wireless BP monitors, oximeters, weight scales and a miniature EKG. 

“No individual component will significantly alter patient outcomes,” Benharash said. “Rather a synergy of patient empowerment and access to outpatient counseling and care will allow for alleviation of patient anxiety and early recognition of complications, should they arise. We encourage patients to be engaged in the discharge process early on and to understand that returning home on a weekend does not mean you will have a higher chance of rehospitalization.”