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The Weekend Effect: Is Surgery on Friday Associated With a Greater Risk of Complications?
Mujtaba Khalil1, Jasmine King2, Abdullah Altaf2
1Department of Surgery, University of Wisconsin - Madison, Madison, Wisconsin.
The Journal of Surgical Research
|April 2, 2026
Summary
Patients undergoing major surgery before the weekend had worse outcomes and were less likely to achieve textbook outcomes (TO). This highlights potential vulnerabilities in weekend hospital operations impacting surgical care quality.
Area of Science:
- Healthcare Operations
- Surgical Outcomes Research
- Patient Safety
Background:
- Healthcare systems adapt workflows weekly, potentially affecting inpatient care quality between weekdays and weekends.
- The 'weekend effect' in healthcare may influence patient outcomes, particularly after major surgical procedures.
Purpose of the Study:
- To investigate the association between the weekend effect and postoperative outcomes.
- To compare textbook outcomes (TO) for patients undergoing major surgery before versus after the weekend.
Main Methods:
- Analysis of Medicare beneficiaries undergoing major surgery (2016-2021).
- Major surgeries included: coronary artery bypass grafting, abdominal aortic aneurysm repair, pneumonectomy, pancreatectomy, and colectomy.
- Multivariable models compared TO for preweekend versus postweekend surgery.
Main Results:
- Preweekend surgery was linked to lower rates of achieving TO (44.9% vs. 49.4%).
- Patients having preweekend surgery experienced higher intensive care unit utilization, complications, readmissions, and mortality.
- Multivariable analysis showed preweekend surgery was associated with 7% lower odds of TO.
Conclusions:
- Hospital operational adjustments during weekends may create risks in surgical care delivery.
- Preweekend surgery is associated with poorer surgical outcomes and reduced likelihood of TO.
- Findings apply across various procedures and hospital types, underscoring the impact of timing on surgical success.
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