Do Outcomes in Elective Colon and Rectal Cancer Surgery Differ by Weekday? An Observational Study Using Data From the Dutch ColoRectal Audit

Abstract

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.

Association of day of the week with mortality after elective right hemicolectomy for colon cancer: Case analysis from the National Clinical Database

“…In contrast, the crude 30-day mortality for elective colorectal (colon and rectum) surgery in previous studies was approximately 2.2%-3.5%. 6,22,23,24 The low frequency of events (death) could have simply impeded the detection of a small difference in mortality between days of the week despite the large sample size in the present study.…”

“…To our knowledge, the present study is the first large-scale study investigating the effect of the day of the week on mortality focusing on elective right hemicolectomy for colon cancer instead of using a heterogenous group of patients. [22][23][24][25]…”

“…Accordingly, our hypothesis was that the mortality before risk adjustment was similar throughout the week or slightly lower on Friday, and the mortality after risk adjustment is higher on Friday than on Monday. To our knowledge, the present study is the first large‐scale study investigating the effect of the day of the week on mortality focusing on elective right hemicolectomy for colon cancer instead of using a heterogenous group of patients 22–25 …”

The “Weekday Effect”—Does It Impact Esophageal Cancer Surgery Outcomes?

“…Njjolstad [32] found that surgical treatment of endometrial cancers later in the week was associated with worse outcomes. In contrast, Huijts [33] and Frostberg [34] found no evidence of weekday effect in patients undergoing elective surgery for colon or rectal cancer. Similarly, Visser [35] found no difference in immediate or longterm outcomes after gastrectomy done earlier versus later in the week.…”

Weekday-dependent long-term outcomes in gastrointestinal cancer surgery: a german population-based retrospective cohort study

“…This observation hints at a potential systematic phenomenon tied to operational practices within healthcare settings. However, this ‘weekday effect’ hypothesis is not unanimously supported as other studies found no significant impact of the day of the week on the outcomes of elective oncological resections 6 – 8 . This discrepancy in findings could be attributed to variations in healthcare systems between countries, differences in study design, or disparities in the clinical conditions being studied.…”