Weekend Effect in Emergency Colon and Rectal Cancer Surgery: A Prospective Study Using Data From the Dutch ColoRectal Audit

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  • 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.
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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: p.j.marang@lumc.nl
  • 1.

    Ingraham AM, Cohen ME, Bilimoria KY et al. . Comparison of 30-day outcomes after emergency general surgery procedures: potential for targeted improvement. Surgery 2010;148:217238.

    • Search Google Scholar
    • Export Citation
  • 2.

    Paun BC, Cassie S, MacLean AR et al. . Postoperative complications following surgery for rectal cancer. Ann Surg 2010;251:807818.

  • 3.

    Glance LG, Osler T, Li Y et al. . Outcomes are worse in US patients undergoing surgery on weekends compared with weekdays. Med Care 2016;54:608615.

  • 4.

    Zhou Y, Li W, Herath C et al. . Off-hour admission and mortality risk for 28 specific diseases: a systematic review and meta-analysis of 251 cohorts. J Am Heart Assoc 2016;5:e003102.

    • Search Google Scholar
    • Export Citation
  • 5.

    Aylin P, Yunus A, Bottle A et al. . Weekend mortality for emergency admissions. A large, multicentre study. Qual Saf Health Care 2010;19:213217.

  • 6.

    Cram P, Hillis SL, Barnett M et al. . Effects of weekend admission and hospital teaching status on in-hospital mortality. Am J Med 2004;117:151157.

  • 7.

    Bell CM, Redelmeier DA. Mortality among patients admitted to hospitals on weekends as compared with weekdays. N Engl J Med 2001;345:663668.

    • Search Google Scholar
    • Export Citation
  • 8.

    Hoehn RS, Go DE, Dhar VK et al. . Understanding the “weekend effect” for emergency general surgery. J Gastrointest Surg 2018;22:321328.

  • 9.

    van der Sijp MP, Bastiaannet E, Mesker WE et al. . Differences between colon and rectal cancer in complications, short-term survival and recurrences. Int J Colorectal Dis 2016;31:16831691.

    • Search Google Scholar
    • Export Citation
  • 10.

    Li L, Rothwell PM. Biases in detection of apparent “weekend effect” on outcome with administrative coding data: population based study of stroke. BMJ 2016;353:i2648.

    • Search Google Scholar
    • Export Citation
  • 11.

    Lilford RJ, Chen YF. The ubiquitous weekend effect: moving past proving it exists to clarifying what causes it. BMJ Qual Saf 2015;24:480482.

    • Search Google Scholar
    • Export Citation
  • 12.

    Concha OP, Gallego B, Hillman K et al. . Do variations in hospital mortality patterns after weekend admission reflect reduced quality of care or different patient cohorts? A population-based study. BMJ Qual Saf 2014;23:215222.

    • Search Google Scholar
    • Export Citation
  • 13.

    van Leersum NJ, Snijders HS, Henneman D et al. . The Dutch Surgical Colorectal Audit. Eur J Surg Oncol 2013;39:10631070.

  • 14.

    Kolfschoten NE, Marang van de Mheen PJ, Gooiker GA et al. . Variation in case-mix between hospitals treating colorectal cancer patients in the Netherlands. Eur J Surg Oncol 2011;37:956963.

    • Search Google Scholar
    • Export Citation
  • 15.

    Henneman D, Snijders HS, Fiocco M et al. . Hospital variation in failure to rescue after colorectal cancer surgery: results of the Dutch Surgical Colorectal Audit. Ann Surg Oncol 2013;20:21172123.

    • Search Google Scholar
    • Export Citation
  • 16.

    Henneman D, Ten Berge MG, Snijders HS et al. . Safety of elective colorectal cancer surgery: non-surgical complications and colectomies are targets for quality improvement. J Surg Oncol 2014;109:567573.

    • Search Google Scholar
    • Export Citation
  • 17.

    Henneman D, van Leersum NJ, Ten Berge M et al. . Failure-to-rescue after colorectal cancer surgery and the association with three structural hospital factors. Ann Surg Oncol 2013;20:33703376.

    • Search Google Scholar
    • Export Citation
  • 18.

    Bray BD, Steventon A. What have we learnt after 15 years of research into the ‘weekend effect’? BMJ Qual Saf 2017;26:607610.

  • 19.

    Daams F, Luyer M, Lange JF. Colorectal anastomotic leakage: aspects of prevention, detection and treatment. World J Gastroenterol 2013;19:22932297.

    • Search Google Scholar
    • Export Citation
  • 20.

    Doeksen A, Tanis PJ, Vrouenraets BC et al. . Factors determining delay in relaparotomy for anastomotic leakage after colorectal resection. World J Gastroenterol 2007;13:37213725.

    • Search Google Scholar
    • Export Citation
  • 21.

    Sheetz KH, Dimick JB, Ghaferi AA. Impact of hospital characteristics on failure to rescue following major surgery. Ann Surg 2016;263:692697.

    • Search Google Scholar
    • Export Citation
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