Colon Cancer Surgery and Resource Availability at Hospitals on Weekends and Holidays
The likelihood of severe complications after emergency colon cancer surgery is significantly higher over the weekend, according to a study published by Huijts et al in JNCCN – Journal of the National Comprehensive Cancer Network. The research was led by Perla Marang-van de Mheen, PhD, of the Leiden University Medical Centre, the Netherlands, and funded by the Dutch Cancer Foundation.
The study examined 5,052 patients who underwent emergency colon cancer surgery at any Dutch hospital between 2012 and 2015, plus another 172 emergency rectal cancer surgery recipients. Researchers used data from the Dutch ColoRectal Audit, which contains a wide range of information on patient and tumor characteristics, treatment, and complications.
Planned surgeries were omitted from the study, and weekends were defined as Saturday and Sunday, plus any national holidays. Severe complications were defined as any postoperative complication that led to a hospital stay of more than 14 days or required an additional operation. Of the 5,052 patients who underwent emergency colon cancer surgery during the study’s time period, 4,244 (84%) were carried out on a weekday vs 808 (16%) during the weekend.
Study Findings
Researchers found—after adjusting for case-mix—that weekend surgeries had a 66% higher mortality rate and a 29% higher severe complication rate compared to Monday surgeries.
The published results include a call for more research, particularly regarding how care is organized across various hospitals during the weekend, not just for the preoperative period but also for postoperative care. These results are probably 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,” said Dr. Marang-van De Mheen.
“Allocating appropriate resources during weekends and holidays is critical to achieving outcomes that are just as good on the weekends as they are during the workweek,” said Steven Nurkin, MD, MS, FACS, Associate Professor in the Department of Surgical Oncology, Roswell Park Comprehensive Cancer Center. Dr. Nurkin is a member of the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) Panel for Colorectal Cancers. “The authors should be commended on a very timely study. These results are concerning, and need to be seriously considered. However, I think we need to be careful in extrapolating just from this study that surgical patients have significantly worse outcomes on the weekends. 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. 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.”
“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,” concluded Dr. Marang-van De Mheen.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
