Surgical Outcomes Following Pre-Weekend Minimally Invasive Gynecologic Surgery (MIGS)

INTRODUCTION: The “weekend effect” refers to the observed increase in complications, hospital readmission, and mortality for patients undergoing surgery immediately before or during the weekend. Prior studies have demonstrated that for elective operations, the risk of postoperative mortality rises in a graded fashion as the surgical day approaches the weekend, with Friday procedures associated with up to 24% higher odds of short-term mortality compared to Monday. This effect is consistent across surgical subspecialties and has been reported in both North American and international cohorts. Beyond mortality, the increased risk extends to complications and hospital readmissions at 30, 90, and 365 days postoperatively. The mechanisms underlying the weekend effect are multifactorial and include reduced staffing levels, decreased availability of senior clinicians, less familiarity with patients, and limited diagnostic and interventional resources during weekends. However, further research is needed to clarify the effectiveness of these interventions. OBJECTIVE: To determine whether perioperative outcomes following minimally invasive gynecologic surgery (MIGS) at our institution are influenced by the weekend effect. METHODS: This is a retrospective cohort study at a tertiary care academic medical center. Patients who underwent minimally invasive gynecologic surgery between January 1, 2009, and December 31, 2019, were included. Surgeries were divided into two groups based on timing: Friday (pre-weekend, n=734) and Monday (post weekend, n=1070). Baseline characteristics were compared, and perioperative outcomes including estimated blood loss, operative time, length of stay, conversion to open surgery, and Clavien–Dindo postoperative complication rates were analyzed. RESULTS: A total of 1,804 surgical cases were included. Baseline demographics, including race, age, prior surgical history, and body mass index, were similar between groups. Median estimated blood loss was significantly higher in the post-weekend group (55 mL; IQR 55) compared with the pre-weekend group (30 mL; interquartile range 30; p=0.0005). Operative times were slightly longer post-weekend (100.4±60.6 minutes) compared with pre-weekend (96.1±59.8 minutes), but this difference was not statistically significant (p=0.1572). No differences were found in length of stay, conversion to open surgery, or major complications, including bowel or bladder or ureter injury. Clavien–Dindo complication rates were overall similar (p=0.208), although Grade II complications were more frequent in the pre-weekend group (13.5% compared with 10.8%). CONCLUSIONS: In contrast to the existing literature, no significant differences were found in major complication rates or operative time between pre- and post-weekend minimally invasive gynecologic surgery procedures, suggesting the weekend effect is not universal. Post-weekend surgeries were associated with a statistically significant increase in EBL, although the clinical impact is likely limited. Further research is needed to explore potential systemic or staffing-related contributors to perioperative variations across the surgical week.