The weekend effect IS real: Patients are 15% more likely to die on Saturday or Sunday


The weekend effect IS real: Patients are 15% more likely to die if they need hospital treatment on a Saturday or Sunday

  • Non-emergency operations 70% more deadly at weekend, global study found 
  • But experts say higher death rates on weekends aren’t reflection of poorer care
  • They say it’s result of weekend patients being sicker and frailer when admitted 

Patients taken to hospitals at weekends are 16 per cent more likely to die than those admitted during the week, a major study suggests.

Researchers found non-emergency operations – such as hip and knee replacements – are 70 per cent more deadly when performed on the weekend compared to a week day.  

But experts believe while a ‘weekend effect’ exists, the higher death rates are not a reflection of poorer care in hospitals on Saturdays and Sundays. 

Instead, they claim it is likely the result of patients needing treatment at weekends being sicker and frailer when they are admitted to hospital.  

Patients taken to hospitals at weekends are 16 per cent more likely to die than those admitted during the week

Experts say higher deaths at weekends may be due to complications forcing pre-planned operations to be moved forward or pushed back to Saturdays and Sundays.

They believe such errors could slip past an administrative database and add to the increased mortality rate at the weekend.

On the other hand, researchers say elective admissions might be overlooked due to hospitals being configured to care for emergencies at weekends. 

The largest-ever review into the ‘weekend effect’ analysed more than 640million admissions worldwide, including in the NHS.

University of Warwick researchers reviewed 68 studies from 11 countries that looked at weekend mortality rates. 

Writing in the British Medical Journal Open, the academics found the weekend effect varied by type of admissions.

Elective admissions – pre-planned hospital visits, usually for operations – were the most fatal at 70 per cent. 

Emergency admissions resulted in 11 per cent more deaths at weekends compared with during the week.

And maternity admissions on a Saturday or Sunday had a six per cent increased risk of death, according to the review.

However, the researchers were keen to point out their analysis focused on mixed studies that skewed the average mortality rate.


The ‘weekend effect’ that is said to make surgery on Saturday or Sunday riskier has been blamed on a lack of skilled senior staff.

Senior doctors – consultants – are rarely present at weekends and there are no staff on hand to carry out x-rays, blood tests or other vital scans.

Health Secretary Jeremy Hunt has previously cited evidence of the issue in his attempt to push for a seven-day NHS.


Data of more than 16.3 million patient admissions, collected by the health service and released in October, backed up his claims.

They showed those brought in for operations over the weekend were 15 per cent more likely to die within 30 days.

And Sir Bruce Keogh, medical director of the NHS, once calculated that 11,000 deaths a year are down to the ‘weekend effect’.

Just 18 of the 68 studied they reviewed included all three types of admissions – explaining why the overall death was 16 per cent higher at weekends. 

The research was funded by the National Institute for Health Research (NIHR) as the Government reviews NHS England’s 7-Day Service programme. 

The ‘weekend effect’ was one of the key arguments used by the Government to push for the programme – and a new contract for junior doctors – in 2017. 

Then-Health Secretary Jeremy Hunt repeatedly claimed understaffing at hospitals during the weekend was causing 11,000 excess deaths every year. 

But the Warwick study found little evidence to suggest differences in staffing levels was to blame for a higher risk of death at weekends. 

Other studies have dismissed the ‘weekend effect’ entirely. 

Research by Oxford University in 2016 found the discrepancies in death rates was down to errors in the way deaths are recorded – or ‘coded’. 

It claimed that when the inaccuracies are stripped out, the weekend effect disappears completely. 

Lead author Dr Yen-Fu Chen, of Warwick University, said the increased mortality rate at weekends was being obscured by a host of other factors not considered in the review. 

He said: ‘[Death] can be influenced by many different factors, such as patient’s condition when admitted, the quality of care he or she received during hospital stay, as well as issues related to discharge arrangement and how data surrounding the admission were recorded.’

While not ruling poorer care out completely, he said evidence to support the argument was ‘sparse and somewhat conflicting’.

University of Birmingham Professor Julian Bion, principal investigator of the HiSLAC project, said patients admitted to hospital at weekends are ‘sicker’ and more of them ‘require admission directly to intensive care’.

He added: ‘It is also likely that elective admissions, usually for surgical operations, at weekends are those with more urgent problems and more complicated issues, which will contribute to the higher mortality.’  

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