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Peer-reviewedCC BY-NC-NDJTCVS open

Weekend versus weekday cardiac surgery: A comprehensive meta-analysis of more than 500,000 cases with meta-regression.

  • Kristine Santos1,2
  • Joo Young Belen Kim Kim3
  • Clara Campoverde Fárez4
  • Bezalel Hakkeem5
  • Ghislain Irakoze Habiyambere6
  • Mario Saul Lira-Castañeda7
  • Tomasz Płonek2,8
8 affiliations
  1. 1New Vision University School of Medicine, Tbilisi, Georgia.
  2. 2Department of Cardiothoracic Surgery, Medisch Spectrum Twente, Enschede, The Netherlands.
  3. 3Faculty of Medical Sciences, Universidad Nacional de Asunción, Asunción, Paraguay.
  4. 4Faculty of Medical Sciences, Universidad de Cuenca, Cuenca, Ecuador.
  5. 5Government Medical College Kozhikode, Kerala, India.
  6. 6University of Global Health Equity, Burera, Rwanda.
  7. 7Facultad de Medicina y Nutrición, Universidad Juarez del Estado de Durango, Durango, Mexico.
  8. 8Faculty of Medicine, Wroclaw University of Science and Technology, Wroclaw, Poland.
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Abstract

Objectives

The "weekend effect" describes worse outcomes with weekend hospital care, but its impact on cardiac surgery remains unclear. We performed a comprehensive meta-analysis and meta-regression to assess whether weekend cardiac surgery is associated with poorer perioperative outcomes than weekday procedures.Methods

PubMed, Scopus, and the Cochrane Library were systematically searched for studies comparing weekend versus weekday cardiac surgery outcomes. Pooled odds ratios (ORs) and mean differences with 95% CIs were calculated using a random-effects model. Subgroup analyses were performed by procedure type (emergent, coronary artery bypass grafting, acute type A aortic dissection) and geographic region. Meta-regressions explored effects of mean age, percentage of female patients, proportion of emergent cases, and publication year. A day-by-day mortality heat map was constructed to assess daily trends.Results

Seventeen studies comprising 527,195 patients were included; 7.4% underwent surgery on weekends. Weekend surgery was associated with significantly greater mortality (OR, 1.5; 95% CI, 1.2-1.8; P = .001) and longer stay in the intensive care unit (mean difference, 0.4 days; 95% CI, 0.1-0.7; P = .01). No significant differences were found for acute kidney injury, stroke, aortic crossclamp time, reoperation for bleeding, or total hospital stay. The incidence of transient ischemic attack was slightly lower on weekends (OR, 0.8; 95% CI, 0.6-1.0; P = .02). Subgroup analyses showed consistently elevated mortality in weekend cases across emergent, coronary artery bypass grafting, and acute type A aortic dissection subgroups, and in studies from Asia and the United States but not Europe. Meta-regression showed no significant effect of age, sex, emergent case proportion, or publication year on mortality differences.Conclusions

Weekend cardiac surgery is associated with greater mortality and longer stay in the intensive care unit, independent of case mix. The absence of patient-level effect modification suggests that systemic or institutional factors, rather than patient acuity, underlie the weekend effect, supporting the need for policies ensuring consistent care across all days.

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Cite

BibTeXRIS
BibTeX
@article{santos2026weekend,
  title = {{Weekend versus weekday cardiac surgery: A comprehensive meta-analysis of more than 500,000 cases with meta-regression.}},
  author = {Kristine Santos and Joo Young Belen Kim Kim and Clara Campoverde Fárez and Bezalel Hakkeem and Ghislain Irakoze Habiyambere and Mario Saul Lira-Castañeda and Tomasz Płonek},
  journal = {JTCVS open},
  year = {2026},
  month = jul,
  doi = {10.1016/j.xjon.2026.101978},
  url = {https://europepmc.org/article/MED/42948441},
  note = {CC BY-NC-ND},
}
RIS
TY  - JOUR
TI  - Weekend versus weekday cardiac surgery: A comprehensive meta-analysis of more than 500,000 cases with meta-regression.
AU  - Kristine Santos
AU  - Joo Young Belen Kim Kim
AU  - Clara Campoverde Fárez
AU  - Bezalel Hakkeem
AU  - Ghislain Irakoze Habiyambere
AU  - Mario Saul Lira-Castañeda
AU  - Tomasz Płonek
PY  - 2026
DA  - 2026/07/30
JO  - JTCVS open
DO  - 10.1016/j.xjon.2026.101978
UR  - https://europepmc.org/article/MED/42948441
AB  - Objectives  The "weekend effect" describes worse outcomes with weekend hospital care, but its impact on cardiac surgery remains unclear. We performed a comprehensive meta-analysis and meta-regression to assess whether weekend cardiac surgery is associated with poorer perioperative outcomes than weekday procedures.Methods  PubMed, Scopus, and the Cochrane Library were systematically searched for studies comparing weekend versus weekday cardiac surgery outcomes. Pooled odds ratios (ORs) and mean differences with 95% CIs were calculated using a random-effects model. Subgroup analyses were performed by procedure type (emergent, coronary artery bypass grafting, acute type A aortic dissection) and geographic region. Meta-regressions explored effects of mean age, percentage of female patients, proportion of emergent cases, and publication year. A day-by-day mortality heat map was constructed to assess daily trends.Results  Seventeen studies comprising 527,195 patients were included; 7.4% underwent surgery on weekends. Weekend surgery was associated with significantly greater mortality (OR, 1.5; 95% CI, 1.2-1.8; P = .001) and longer stay in the intensive care unit (mean difference, 0.4 days; 95% CI, 0.1-0.7; P = .01). No significant differences were found for acute kidney injury, stroke, aortic crossclamp time, reoperation for bleeding, or total hospital stay. The incidence of transient ischemic attack was slightly lower on weekends (OR, 0.8; 95% CI, 0.6-1.0; P = .02). Subgroup analyses showed consistently elevated mortality in weekend cases across emergent, coronary artery bypass grafting, and acute type A aortic dissection subgroups, and in studies from Asia and the United States but not Europe. Meta-regression showed no significant effect of age, sex, emergent case proportion, or publication year on mortality differences.Conclusions  Weekend cardiac surgery is associated with greater mortality and longer stay in the intensive care unit, independent of case mix. The absence of patient-level effect modification suggests that systemic or institutional factors, rather than patient acuity, underlie the weekend effect, supporting the need for policies ensuring consistent care across all days.
SN  - 2666-2736
ER  -