Journal
EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY
Volume 57, Issue 6, Pages 1130-1136Publisher
OXFORD UNIV PRESS INC
DOI: 10.1093/ejcts/ezz379
Keywords
Coronary artery disease; Perioperative care; Quality care; Weekend effect
Funding
- National Heart, Lung, and Blood Institute [T32 HL007849, UM1 HL088925]
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OBJECTIVES: A weekend effect with increased mortality has previously been reported in surgical patients and those with acute myocardial infarction (MI). We hypothesized that a similar phenomenon may exist in coronary artery bypass grafting (CABG). METHODS: Patients undergoing non-elective isolated CABG (2011-2017) were included from a multicentre regional Society of Thoracic Surgeons database. Patients were stratified by weekend versus weekday operations and further analysed by specific day of the week. RESULTS: A total of 14 374 patients underwent urgent or emergency isolated CABG with 410 (2.9%) operated on over the weekend. Weekend operations were more often emergency (36.1% vs 5.0%, P<0.001) and more likely to be in the setting of MI (70.0% vs 51.2%, P<0.001). Cardiopulmonary bypass times were similar [91 min (71-114) vs 94 min (74-117), P=0.0749] and the frequency of complete revascularization equivalent (83.4% vs 85.3%, P=0.284) between weekend and weekday operations. In risk-adjusted analyses, there was no increased odds for mortality in patients operated on over the weekend [odds ratio (OR) 1.07, P=0.811]; however, there was an increased odds of major morbidity (OR 1.37, P=0.034). Furthermore, compared with Monday, morbidity increased as the operative day approached the weekend (Tuesday 0.98, P=0.828; Wednesday 1.07, P=0.469; Thursday 1.12, P=0.229; Friday 1.19, P=0.041; weekend 1.47, P=0.014). CONCLUSIONS : While patients requiring surgery on the weekend are higher risk, there is no independent effect of weekend surgery on mortality. However, these patients are at increased risk for major morbidity, the causes of which require further investigation.
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