The likelihood of severe complications after emergency colon cancer surgery is significantly higher over the weekend, according to a study in the latest issue of JNCCN – Journal of the National Comprehensive Cancer Network.
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. It found, after adjusting for case-mix, that weekend surgeries had a 66 percent higher mortality rate, and a 29 percent higher severe complication rate, compared to Monday surgeries.
The study, ”Weekend Effect in Emergency Colon and Rectal Cancer Surgery: A Prospective Study Using Data From the Dutch ColoRectal Audit,” was led by Perla Marang-van de Mheen of the Leiden University Medical Centre, Netherlands, and funded by the Dutch Cancer Foundation.
The 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 post-operative 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 percent) were carried out on a weekday, versus 808 (16 percent) during the weekend.
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 pre-operative period, but also for post-operative 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, associate professor in the Department of Surgical Oncology at Roswell Park Comprehensive Cancer Center, and a member of the NCCN Clinical Practice Guidelines in Oncology 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,” Marang-van De Mheen said.
