Background: Previous studies showing higher mortality after elective surgery performed on a Friday were based on administrative data, known for insufficient case-mix adjustment. The goal of this study was to investigate the risk of adverse events for patients with colon and rectal cancer by day of elective surgery using clinical data from the Dutch ColoRectal Audit. Patients and Methods: Prospectively collected data from the 2012–2015 Dutch ColoRectal Audit (n=36,616) were used to examine differences in mortality, severe complications, and failure to rescue by day of elective surgery (Monday through Friday). Monday was used as a reference, analyses were stratified for colon and rectal cancer, and case-mix adjustments were made for previously identified variables. Results: For both colon and rectal cancer, crude mortality, severe complications, and failure-to-rescue rates varied by day of elective surgery. After case-mix adjustment, lower severe complication risk was found for rectal cancer surgery performed on a Friday (odds ratio, 0.84; 95% CI, 0.72–0.97) versus Monday. No significant differences were found for colon cancer surgery performed on different weekdays. Conclusions: No weekday effect was found for elective colon and rectal cancer surgery in the Netherlands. Lower severe complication risk for elective rectal cancer surgery performed on a Friday may be caused by patient selection.
Submitted October 22, 2018; accepted for publication February 6, 2019.
Author contributions:Study design: Guicherit, Marang-van de Mheen. Data analysis and interpretation: Huijts, Dekker, van Groningen, Marang-van de Mheen. Manuscript preparation: Huijts, Marang-van de Mheen. Critical revision: Guicherit, Dekker, van Groningen, van Bodegom-Vos, Bastiaannet, Govaert, Wouters, Marang-van de Mheen.
Disclosures: The authors have disclosed that they have no financial interests, arrangements, or affiliations with the manufacturers of any products discussed in this article or their competitors.
Funding: This study was funded by an unrestricted grant from the Dutch Cancer Society (UL2015-7772). The Dutch Cancer Society did not influence the article in any way.
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: email@example.com
HennemanD, Ten BergeMG, SnijdersHS, . Safety of elective colorectal cancer surgery: non-surgical complications and colectomies are targets for quality improvement. J Surg Oncol 2014;109:567–573.2433862710.1002/jso.23532)| false
GovaertJA, FioccoM, van DijkWA, . Costs of complications after colorectal cancer surgery in the Netherlands: building the business case for hospitals. Eur J Surg Oncol 2015;41:1059–1067.10.1016/j.ejso.2015.03.23625960291)| false
SmithSA, YamamotoJM, RobertsDJ, . Weekend surgical care and postoperative mortality: a systematic review and meta-analysis of cohort studies. Med Care 2018;56:121–129.10.1097/MLR.000000000000086029251716)| false
AylinP, AlexandrescuR, JenMH, . Day of week of procedure and 30 day mortality for elective surgery: retrospective analysis of hospital episode statistics. BMJ 2013;346:f2424.10.1136/bmj.f242423716356)| false
RuizM, BottleA, AylinPP. The Global Comparators project: international comparison of 30-day in-hospital mortality by day of the week. BMJ Qual Saf 2015;24:492–504.2615055010.1136/bmjqs-2014-003467)| false
van der SijpMP, BastiaannetE, MeskerWE, . Differences between colon and rectal cancer in complications, short-term survival and recurrences. Int J Colorectal Dis 2016;31:1683–1691.10.1007/s00384-016-2633-3)| false
HennemanD, van LeersumNJ, Ten BergeM, . Failure-to-rescue after colorectal cancer surgery and the association with three structural hospital factors. Ann Surg Oncol 2013;20:3370–3376.2373285910.1245/s10434-013-3037-z)| false
KolfschotenNE, Marang van de MheenPJ, GooikerGA, . Variation in case-mix between hospitals treating colorectal cancer patients in the Netherlands. Eur J Surg Oncol 2011;37:956–963.10.1016/j.ejso.2011.08.13721944049)| false
HuijtsDD, van GroningenJT, GuicheritOR, . Weekend effect in emergency colon and rectal cancer surgery: a prospective study using data from the Dutch ColoRectal Audit. J Natl Compr Canc Netw2018;16:735–741.
HuijtsDD, van GroningenJT, GuicheritOR, . Weekend effect in emergency colon and rectal cancer surgery: a prospective study using data from the Dutch ColoRectal Audit. J Natl Compr Canc Netw 2018;16:735–741.2989152510.6004/jnccn.2018.7016)| false
HennemanD, SnijdersHS, FioccoM, . Hospital variation in failure to rescue after colorectal cancer surgery: results of the Dutch Surgical Colorectal Audit. Ann Surg Oncol 2013;20:2117–2123.10.1245/s10434-013-2896-723417434)| false
RuizM, BottleA, AylinPP. Exploring the impact of consultants’ experience on hospital mortality by day of the week: a retrospective analysis of hospital episode statistics. BMJ Qual Saf 2016;25:337–344.10.1136/bmjqs-2015-004105)| false