Prognosis following cancer surgery during holiday periods

Abstract

Surgery is the mainstay curative treatment in most cancer. We aimed to test the new hypothesis that cancer surgery performed during holiday periods is associated with worse long-term prognosis than for non-holiday periods. This nationwide Swedish population-based cohort study included 228,927 patients during 1997-2014 who underwent elective resectional surgery for a cancer where the annual number of resections was over 100. The 16 eligible cancer sites were grouped into 10 cancer groups. The exposure, holiday periods, was classified as wide (14-weeks) or narrow (7-weeks). Surgery conducted inside versus outside holiday periods was compared regarding overall disease-specific (main outcome) and overall all-cause (secondary outcome) mortality. Cox regression provided hazard ratios (HR) with 95% confidence intervals (CI) adjusted for age, sex, comorbidity, hospital volume, calendar period and tumor stage. Surgery conducted during wide and narrow holiday periods were associated with increased HRs of disease-specific mortality for cancer of the breast (HR 1.08, 95% CI 1.03-1.13 and HR 1.06, 95% CI 1.01-1.12) and possibly of cancer of the liver-pancreas-bile ducts (HR 1.09, 95% CI 0.99-1.20 and HR 1.12, 95% CI 0.99-1.26). Sub-groups with cancer of the colon-rectum, head-and-neck, prostate, kidney-urine bladder and thyroid also experienced statistically significantly worse prognosis following surgery conducted during holiday periods. No influence of surgery during holiday was detected for cancer of the esophagus-stomach, lung or ovary-uterus. All-cause HRs were similar to the disease-specific HRs. The prognosis following cancer surgery might not be fully maintained during holiday periods for all cancer sites.

Period‐specific mean annual hospital volume of radical cystectomy is associated with outcome and perioperative quality of care: a nationwide population‐based study

“…Treatment delay is associated with survival in patients with bladder cancer subjected to RC. Thus there is evidence that, to improve survival, centralisation of RC care should be combined with maintaining high hospital volume and consistent care over seasons , and ensuring a treatment delay of <3 months.…”

Seasonal variations in pancreatic surgery outcome A retrospective time-trend analysis of 2748 Whipple procedures

“…2 ). Although it is difficult to identify a cause-effect relationship, this paper is in line with multiple others on the same topic assuming that specific cultural and environmental factors (e.g., vacations) might play a major role in medical and surgical outcomes [ 10 – 12 ].…”

“…A third mechanism that can explain seasonal variations in surgical outcomes is staff and resource shortage during vacation periods. Several studies have demonstrated worse outcomes for procedures performed on Fridays [10], on weekends [11] or during vacation or holiday periods [12], regardless of the specific month in which they take place worldwide [30,31]. During holidays, hospital systems are significantly disrupted, as significant segments of the staff are off work and care capacity is usually delivered by less experienced/occasional staff and with less overall resource availability.…”

“…Another pattern characterized by outcome deterioration has been linked to sabbaticals. Several studies have reported increased morbidity and worse survival outcomes after major oncological procedures performed on Fridays [10], during the weekend [11] or on holidays [12] due to the shortage of medical and nursing staff.…”

Surgical and Surgeon-Related Factors Related to Long-Term Survival in Esophageal Cancer: A Review

“…31 Patients who underwent esophagectomy during holiday periods did not seem to have any worse survival than those who had surgery during non-holiday periods according to two population-based and nationwide Swedish cohort studies. 32,33 Summary of Surgeon-Related Factors. Surgeon volume seems to have a substantial influence on the chance of longterm survival after esophagectomy for esophageal cancer.…”