{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T04:24:48Z","timestamp":1793420688005,"version":"4.5.0"},"reference-count":33,"publisher":"American Medical Association (AMA)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>The phenomenon of a weekend effect<\/jats:italic> refers to a higher potential for adverse outcomes in patients receiving care over the weekend. Few prior studies have comprehensively investigated the effects of postoperative weekend care on surgical outcomes in a generalizable cohort.<\/jats:p><\/jats:sec>Objective<\/jats:title>To examine differences in short-term and long-term postoperative outcomes of patients undergoing surgical procedures immediately before vs after the weekend.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This is a population-based, retrospective cohort secondary analysis of adult patients in Ontario, Canada, undergoing 1 of 25 common surgical procedures between January 1, 2007, to December 31, 2019, with 1 year of follow-up. Data analysis was performed from October to November 2022.<\/jats:p><\/jats:sec>Exposure<\/jats:title>Undergoing surgery before (1 day before) vs after (1 day after) the weekend.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>The primary outcome was a composite of death, readmission, and complications at 30 days, 90 days, and 1 year. Multivariable generalized estimating equations with an independent correlation structure, accounting for covariates, with clustering on surgical procedure were used to estimate the association between day of surgery in relation to the weekend and the outcomes.<\/jats:p><\/jats:sec>Results<\/jats:title>Of the 429\u202f691 patients (mean [SD] age, 58.6 [16.9] years; 270\u202f002 female patients [62.8%]) in the study cohort, 199\u202f744 (46.5%) underwent surgery before the weekend, and 229\u202f947 (53.5%) underwent surgery after the weekend. Patients in the preweekend group were more likely than those in the postweekend group to experience the composite outcome of death, complications, and readmissions at 30 days (adjusted odds ratio [aOR], 1.05; 95% CI, 1.02-1.08), 90 days (aOR, 1.06; 95% CI, 1.03-1.09), and 1 year (aOR, 1.05; 95% CI, 1.02-1.09) after surgery. Odds of mortality were increased in the preweekend group vs the postweekend group at 30 days (aOR, 1.09; 95% CI, 1.03-1.16), 90 days (aOR, 1.10; 95% CI, 1.03-1.17), and 1 year (aOR, 1.12; 95% CI, 1.08-1.17).<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>In this retrospective multi-institutional study, patients who underwent surgery immediately preceding the weekend had a significantly increased risk of complications, readmissions, and mortality compared with those treated after the weekend. Further study is needed to understand differences in care that may underpin these observations and ensure that patients receive high-quality care regardless of the day of the week.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2024.58794","type":"journal-article","created":{"date-parts":[[2025,3,4]],"date-time":"2025-03-04T16:30:49Z","timestamp":1741105849000},"page":"e2458794","source":"Crossref","is-referenced-by-count":16,"title":["Postoperative Outcomes Following Preweekend Surgery"],"prefix":"10.1001","volume":"8","author":[{"given":"Sanjana","family":"Ranganathan","sequence":"first","affiliation":[{"name":"Department of Urology, Houston Methodist Hospital, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos","family":"Riveros","sequence":"additional","affiliation":[{"name":"Department of Urology, Houston Methodist Hospital, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yusuke","family":"Tsugawa","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, California"},{"name":"Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Geng","sequence":"additional","affiliation":[{"name":"Department of Urology, Houston Methodist Hospital, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vatsala","family":"Mundra","sequence":"additional","affiliation":[{"name":"Department of Urology, Houston Methodist Hospital, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zachary","family":"Melchiode","sequence":"additional","affiliation":[{"name":"Department of Urology, Houston Methodist Hospital, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bheeshma","family":"Ravi","sequence":"additional","affiliation":[{"name":"Division of Orthopedic Surgery, Department of Surgery, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada"},{"name":"Division of Orthopedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalie","family":"Coburn","sequence":"additional","affiliation":[{"name":"Division of Surgery, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela","family":"Jerath","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allan S.","family":"Detsky","sequence":"additional","affiliation":[{"name":"Department of Medicine, Mount Sinai Hospital and University Health Network, Toronto, Ontario, Canada"},{"name":"Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada"},{"name":"Department of Medicine, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher J. D.","family":"Wallis","sequence":"additional","affiliation":[{"name":"Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada"},{"name":"Division of Urology, Department of Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada"},{"name":"Department of Surgical Oncology, University Health Network, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raj","family":"Satkunasivam","sequence":"additional","affiliation":[{"name":"Department of Urology, Houston Methodist Hospital, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2025,3,4]]},"reference":[{"issue":"2","key":"zoi241642r1","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1002\/jhm.2310","article-title":"Similar outcomes among general medicine patients discharged on weekends.","volume":"10","author":"McAlister","year":"2015","journal-title":"J Hosp Med"},{"issue":"3","key":"zoi241642r2","doi-asserted-by":"publisher","first-page":"175","DOI":"10.1016\/j.amjmed.2004.02.047","article-title":"Waiting for urgent procedures on the weekend among emergently hospitalized patients.","volume":"117","author":"Bell","year":"2004","journal-title":"Am J Med"},{"issue":"2","key":"zoi241642r3","doi-asserted-by":"publisher","first-page":"508","DOI":"10.1016\/j.surg.2015.02.024","article-title":"The \u201cweekend effect\u201d in urgent general operative procedures.","volume":"158","author":"Zapf","year":"2015","journal-title":"Surgery"},{"issue":"3","key":"zoi241642r4","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.115.003102","article-title":"Off-hour admission and mortality risk for 28 specific diseases: a systematic review and meta-analysis of 251 cohorts.","volume":"5","author":"Zhou","year":"2016","journal-title":"J Am Heart Assoc"},{"issue":"2","key":"zoi241642r5","doi-asserted-by":"publisher","first-page":"74","DOI":"10.1258\/jrsm.2012.120009","article-title":"Weekend hospitalization and additional risk of death: an analysis of inpatient data.","volume":"105","author":"Freemantle","year":"2012","journal-title":"J R Soc Med"},{"issue":"5","key":"zoi241642r6","doi-asserted-by":"publisher","first-page":"322","DOI":"10.1016\/j.ejim.2006.01.003","article-title":"Mortality among adult patients admitted to the hospital on weekends.","volume":"17","author":"Barba","year":"2006","journal-title":"Eur J Intern Med"},{"issue":"1","key":"zoi241642r7","doi-asserted-by":"publisher","first-page":"186","DOI":"10.1016\/j.surg.2020.12.033","article-title":"The weekday effect on postoperative mortality in elective abdominal surgery: an observational study using propensity score methods.","volume":"170","author":"Kang","year":"2021","journal-title":"Surgery"},{"issue":"5","key":"zoi241642r8","doi-asserted-by":"publisher","first-page":"866","DOI":"10.1097\/SLA.0b013e3180cc2e60","article-title":"Mortality after nonemergent major surgery performed on Friday versus Monday through Wednesday.","volume":"246","author":"Zare","year":"2007","journal-title":"Ann Surg"},{"key":"zoi241642r9","doi-asserted-by":"publisher","first-page":"f2424","DOI":"10.1136\/bmj.f2424","article-title":"Day of week of procedure and 30 day mortality for elective surgery: retrospective analysis of hospital episode statistics.","volume":"346","author":"Aylin","year":"2013","journal-title":"BMJ"},{"issue":"2","key":"zoi241642r10","doi-asserted-by":"publisher","first-page":"156","DOI":"10.1001\/jamaophthalmol.2019.5253","article-title":"Association of rhegmatogenous retinal detachment and outcomes with the day of the week that patients undergo a repair or receive a diagnosis.","volume":"138","author":"Vail","year":"2020","journal-title":"JAMA Ophthalmol"},{"issue":"7","key":"zoi241642r11","doi-asserted-by":"publisher","first-page":"551","DOI":"10.1308\/rcsann.2018.0084","article-title":"There is no \u2018weekend effect\u2019 in elective orthopaedic surgery.","volume":"100","author":"Al-Ashqar","year":"2018","journal-title":"Ann R Coll Surg Engl"},{"issue":"4","key":"zoi241642r12","doi-asserted-by":"publisher","first-page":"494","DOI":"10.1093\/neuros\/nyy382","article-title":"Is length of stay influenced by the weekday on which lumbar surgery is performed?","volume":"85","author":"Sivaganesan","year":"2019","journal-title":"Neurosurgery"},{"issue":"5","key":"zoi241642r13","doi-asserted-by":"publisher","first-page":"378","DOI":"10.2500\/ajra.2015.29.4228","article-title":"Impact of day of week on outcomes of endoscopic sinus surgery for chronic rhinosinusitis.","volume":"29","author":"Sedaghat","year":"2015","journal-title":"Am J Rhinol Allergy"},{"issue":"15","key":"zoi241642r14","doi-asserted-by":"publisher","first-page":"E385","DOI":"10.1503\/cmaj.190820","article-title":"Relation between surgeon age and postoperative outcomes: a population-based cohort study.","volume":"192","author":"Satkunasivam","year":"2020","journal-title":"CMAJ"},{"issue":"2","key":"zoi241642r15","doi-asserted-by":"publisher","first-page":"146","DOI":"10.1001\/jamasurg.2021.6339","article-title":"Association of surgeon-patient sex concordance with postoperative outcomes.","volume":"157","author":"Wallis","year":"2022","journal-title":"JAMA Surg"},{"issue":"1","key":"zoi241642r16","doi-asserted-by":"publisher","first-page":"81","DOI":"10.1097\/SLA.0000000000005495","article-title":"Association between surgeon and anesthesiologist sex discordance and postoperative outcomes: a population-based cohort study.","volume":"276","author":"Wallis","year":"2022","journal-title":"Ann Surg"},{"issue":"8","key":"zoi241642r17","doi-asserted-by":"publisher","first-page":"573","DOI":"10.7326\/0003-4819-147-8-200710160-00010","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies.","volume":"147","author":"von Elm","year":"2007","journal-title":"Ann Intern Med"},{"issue":"9","key":"zoi241642r18","doi-asserted-by":"publisher","first-page":"845","DOI":"10.1056\/NEJMsa1415994","article-title":"Outcomes of daytime procedures performed by attending surgeons after night work.","volume":"373","author":"Govindarajan","year":"2015","journal-title":"N Engl J Med"},{"issue":"11","key":"zoi241642r19","doi-asserted-by":"publisher","first-page":"1029","DOI":"10.1056\/NEJMsa1308261","article-title":"Introduction of surgical safety checklists in Ontario, Canada.","volume":"370","author":"Urbach","year":"2014","journal-title":"N Engl J Med"},{"key":"zoi241642r20","doi-asserted-by":"publisher","first-page":"j4366","DOI":"10.1136\/bmj.j4366","article-title":"Comparison of postoperative outcomes among patients treated by male and female surgeons: a population based matched cohort study.","volume":"359","author":"Wallis","year":"2017","journal-title":"BMJ"},{"issue":"6","key":"zoi241642r21","doi-asserted-by":"publisher","first-page":"1228","DOI":"10.1080\/03610910902859574","article-title":"Using the standardized difference to compare the prevalence of a binary variable between two groups in observational research.","volume":"38","author":"Austin","year":"2009","journal-title":"Commun Stat Simul Comput"},{"issue":"5","key":"zoi241642r22","doi-asserted-by":"publisher","first-page":"337","DOI":"10.1136\/bmjqs-2015-004105","article-title":"Exploring the impact of consultants\u2019 experience on hospital mortality by day of the week: a retrospective analysis of hospital episode statistics.","volume":"25","author":"Ruiz","year":"2016","journal-title":"BMJ Qual Saf"},{"issue":"8","key":"zoi241642r23","doi-asserted-by":"publisher","first-page":"492","DOI":"10.1136\/bmjqs-2014-003467","article-title":"The Global Comparators project: international comparison of 30-day in-hospital mortality by day of the week.","volume":"24","author":"Ruiz","year":"2015","journal-title":"BMJ Qual Saf"},{"issue":"10","key":"zoi241642r24","doi-asserted-by":"publisher","first-page":"988","DOI":"10.1001\/jamasurg.2020.2618","article-title":"Association of weekend effect with recovery after surgery.","volume":"155","author":"Liu","year":"2020","journal-title":"JAMA Surg"},{"issue":"2","key":"zoi241642r25","doi-asserted-by":"publisher","first-page":"121","DOI":"10.1097\/MLR.0000000000000860","article-title":"Weekend surgical care and postoperative mortality: a systematic review and meta-analysis of cohort studies.","volume":"56","author":"Smith","year":"2018","journal-title":"Med Care"},{"issue":"10","key":"zoi241642r26","doi-asserted-by":"publisher","first-page":"1296","DOI":"10.1001\/archneurol.2012.1030","article-title":"Dying for the weekend: a retrospective cohort study on the association between day of hospital presentation and the quality and safety of stroke care.","volume":"69","author":"Palmer","year":"2012","journal-title":"Arch Neurol"},{"issue":"3","key":"zoi241642r27","doi-asserted-by":"publisher","first-page":"303","DOI":"10.1016\/j.cgh.2008.08.033","article-title":"Weekend versus weekday admission and mortality from gastrointestinal hemorrhage caused by peptic ulcer disease.","volume":"7","author":"Shaheen","year":"2009","journal-title":"Clin Gastroenterol Hepatol"},{"issue":"8","key":"zoi241642r28","doi-asserted-by":"publisher","first-page":"E303","DOI":"10.1503\/cmaj.160511","article-title":"Association between day of the week of elective surgery and postoperative mortality.","volume":"189","author":"Dubois","year":"2017","journal-title":"CMAJ"},{"key":"zoi241642r29","first-page":"153","article-title":"Weekly hospital workforce data: a data visualisation exercise.","volume":"239","author":"Xie","year":"2017","journal-title":"Stud Health Technol Inform"},{"issue":"9","key":"zoi241642r30","doi-asserted-by":"publisher","first-page":"1050","DOI":"10.1007\/s11606-011-1715-8","article-title":"Excellent hospital care for all: open and operating 24\/7.","volume":"26","author":"Wong","year":"2011","journal-title":"J Gen Intern Med"},{"issue":"4","key":"zoi241642r31","doi-asserted-by":"publisher","first-page":"1589","DOI":"10.1111\/j.1475-6773.2006.00663.x","article-title":"Do hospitals provide lower quality care on weekends?","volume":"42","author":"Becker","year":"2007","journal-title":"Health Serv Res"},{"issue":"1","key":"zoi241642r32","doi-asserted-by":"publisher","DOI":"10.1259\/bjro.20200046","article-title":"National audit of seven-day working care in radiology.","volume":"3","author":"Bailey","year":"2021","journal-title":"BJR Open"},{"issue":"3","key":"zoi241642r33","doi-asserted-by":"publisher","first-page":"216","DOI":"10.1136\/heart.87.3.216","article-title":"Restricted weekend service inappropriately delays discharge after acute myocardial infarction.","volume":"87","author":"Varnava","year":"2002","journal-title":"Heart"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2830842\/ranganathan_2025_oi_241642_1740155894.62423.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,4]],"date-time":"2025-03-04T16:30:51Z","timestamp":1741105851000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2830842"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,4]]},"references-count":33,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2025,3,3]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2024.58794","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,4]]}}}