a Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Center, Leiden; Dutch Institute for Clinical Auditing, Leiden; Department of Surgery, University Cancer Center Leiden|The Hague, The Hague; Department of Surgery, Reinier de Graaf Group, Delft; Department of Surgery, Leiden University Medical Center, Leiden; and Department of Surgical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, the Netherlands.
Background: It is unclear whether emergency weekend colon and rectal cancer surgery are associated with worse outcomes (ie, weekend effect) because previous studies mostly used administrative data, which may insufficiently adjust for case-mix. Materials and Methods: Prospectively collected data from the 2012–2015 Dutch ColoRectal Audit (n=5,224) was used to examine differences in 30-day mortality and severe complication and failure-to-rescue rates for emergency weekend (Saturday and Sunday) versus Monday surgery, stratified for colon and rectal cancer. Analyses were adjusted for age, sex, body mass index, Charlson comorbidity index, American Society of Anesthesiologists classification score, tumor stage, presence of metastasis, preoperative complication, additional resection for metastasis or locally advanced tumor, location primary colon tumor, type of rectal surgery (lower anterior resection or abdominal perineal resection), and type of neoadjuvant therapy (short-course radiotherapy or chemoradiotherapy). Results: A total of 5,052 patients undergoing colon cancer surgery and 172 undergoing rectal cancer surgery were included. Patients undergoing colon or rectal cancer surgery during weekends had significantly more preoperative tumor complications compared with those undergoing surgery on a weekday. Additionally, differences in year of surgery and location of primary tumor were found for colon cancer surgery. Emergency colon cancer surgery during the weekend was associated with increased 30-day mortality (odds ratio [OR], 1.66; 95% CI, 1.10–2.50) and severe complications (OR, 1.29; 95% CI, 1.03–1.63) compared with surgery on Monday. Estimates for emergency weekend rectal cancer surgery were similar but not statistically significant, likely explained by small numbers. Conclusions: Weekend emergency colon cancer surgery was associated with higher mortality and severe complication rates. More research is needed to understand which factors explain and contribute to these differences.
Author contributions:Study design: Guicherit, Marang-van de Mheen. Data analysis and interpretation: Huijts, van Groningen, Dekker, Marang-van de Mheen. Manuscript preparation: Huijts, Marang-van de Mheen. Critical revision: van Groningen, Guicherit, Dekker, van Bodegom-Vos, Bastiaannet, Govaert, Wouters, Marang-van de Mheen.
Correspondence: Perla J. Marang-van de Mheen, PhD, Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands. Email: firstname.lastname@example.org
ConchaOP, GallegoB, HillmanK
. Do variations in hospital mortality patterns after weekend admission reflect reduced quality of care or different patient cohorts? A population-based study. BMJ Qual Saf2014;23:215–222.
ConchaOPGallegoBHillmanK. Do variations in hospital mortality patterns after weekend admission reflect reduced quality of care or different patient cohorts? A population-based study. BMJ Qual Saf2014;23:215–222.