We would like to thank Drs. Flansbaum and Sheehy for their interest in our article.1 We appreciate their mentioning the highly publicized disputes and additional manuscripts2,3 that were published after our literature review, which was conducted in 2013.
As discussed by Drs. Flansbaum and Sheehy and the editorial accompanying our article,4 the precise contributions, if any, of various potential factors (eg, patient characteristics, resources, workforce) to the development of the weekend effect is uncertain at this time; although, as mentioned by Drs. Flansbaum and Sheehy, more recent work2,3 suggests that patient characteristics may be a more important determinant on outcomes.
Despite the uncertainty surrounding the exact composition and contributions of various elements to the weekend effect, it does appear to be a real phenomenon, as noted by the editorialists.4 We hope that our manuscript encourages future investigators to help elucidate the nature of the input contributing to the weekend effect.