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Emergency colon cancer surgery conducted over weekend has poorer outcomes
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Patients who underwent weekend emergency surgery for colon cancer appeared to have greater mortality and more severe complication rates than patients who underwent surgery on a weekday, according to results of a prospective study.
This finding may be due to “a far more complex interplay between different factors, regarding both the patient and the organization, rather than simply the day of the initial surgery itself,” Perla J. Marang-van de Mheen, PhD, from the department of biomedical data sciences, medical decision-making at Leiden University Medical Center in the Netherlands, said in a press release.
Surgery is commonly used to treat colon and rectal cancers. However, previous research has shown that surgery among this patient population bares considerable risks for postoperative complications and mortality.
Researchers evaluated data from 5,224 individuals in the 2012-2015 Dutch ColoRectal Audit — a nationwide clinical audit in the Netherlands that registers clinical data to meet a goal of measuring and improving quality of colorectal surgery.
Investigators compared 30-day mortality, severe complication and failure-to-rescue rates between patients who underwent emergency surgery on a Saturday or Sunday with patients who underwent surgery on a Monday.
Overall, 5,052 patients underwent colon cancer surgery and 172 underwent rectal cancer surgery.
Of emergency colon cancer surgeries, 4,244 were performed during a weekday and 808 during a weekend. Of emergency rectal cancer surgeries, 150 were performed during a weekday and 22 during a weekend.
Analyses performed included adjustments for age, sex, BMI, 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 and type of neoadjuvant therapy.
Emergency colon cancer surgery on Saturday or Sunday compared with a Monday appeared associated with increased likelihood of 30-day mortality (OR = 1.66; 95% CI, 1.1–2.5) and severe complications (OR = 1.29; 95% CI, 1.03–1.63).
Among patients who underwent emergency colon cancer surgery, the highest mortality (9.9%), severe complication (31.8%) and failure-to-rescue (31.1%) rates were reported on weekends.
After adjustment for case-mix, weekend surgeries had 66% higher mortality and 29% higher severe complication rates than surgeries performed on Monday.
Among patients who underwent emergency rectal cancer surgery, the highest mortality (18.2%), severe complication (45.5%) and failure-to-rescue (40%) rates were also reported on weekends.
Researchers did not observe a significant difference for weekend surgeries in rectal cancer after adjustment for case-mix, likely due to small estimates, the researchers wrote in the study.
Post-hoc analysis showed that during emergency colon cancer surgeries, more ostomies were created on weekends than on weekdays (43.6% vs. 38.8%; P = .018). The number of anastomoses was higher on weekdays than weekends (55.6% vs. 50.1%; P = .018).
Multivariate analyses — with ostomy and anastomosis as the reference category — showed failure to rescue was higher after emergency weekend colon cancer surgeries (OR = 1.66; 95% CI, 1.04–2.66).
“Regardless of whether surgery takes place on a weekend or during the week, it’s always important for patients to report any symptoms right away, to make sure that hospital staff has all the relevant information needed to catch complications early on,” Marang-van de Mheen said in a press release.
Steven Nurkin, MD, MS, FACS, associate professor in the department of surgical oncology at Roswell Park Comprehensive Cancer Center, and member on the NCCN Clinical Practice Guidelines in Oncology Panel for Colorectal Cancers, called the results of the study “concerning,” and that allocating resources during weekends and holidays is important for patients to experience similar outcomes during those times.
However, he emphasized that caution should be taken when interpreting the findings.
“The weekend on-call teams are there for those true emergencies, and the ‘urgent, but not emergent’ surgeries may be delayed until the early workweek,” Nurkin said in a press release. “Those that get operated on during weekends are frequently ‘the sickest of the sick’ and are, therefore, at higher risk of complications and worse outcomes.” – by Melinda Stevens
Disclosures: The authors report no relevant financial disclosures. HemOnc Today could not confirm Nurkin’s relevant financial disclosures at the time of publication.
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