Weekend effect in emergency colon and rectal cancer surgery
A prospective study using data from the Dutch colorectal audit
Daniëlle D. Huijts (Leiden University Medical Center)
Julia T. Van Groningen (Dutch Institute for Clinical Auditing)
Onno R. Guicherit (Universiteit Leiden)
Jan Willem Dekker (Reinier de Graaf Gasthuis)
Leti Van Bodegom-Vos (Leiden University Medical Center)
Esther Bastiaannet (Leiden University Medical Center)
Johannes A. Govaert (Leiden University Medical Center)
Michel W. Wouters (Dutch Institute for Clinical Auditing, Nederlands Kanker Instituut - Antoni van Leeuwenhoek ziekenhuis)
Perla J. Marang-Van De Mheen (Leiden University Medical Center)
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Abstract
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.