The weekday effect on postoperative mortality in elective abdominal surgery: An observational study using propensity score methods

Kang, Kyong Min; Jeong, Ki Seok; Oh, Heung‐Kwon; Kim, Daeryong; Suh, Bongwon; Ahn, Soyeon; Suh, Dong Hoon; Lee, Sangchul; Lee, Ho‐Young; Lee, Jee Hye; Yang, In Jun; Suh, JungWook; Kim, Duck-Woo; Kang, Seung Joo

doi:10.1016/j.surg.2020.12.033

Cited by 6 publications

(6 citation statements)

References 27 publications

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“…Article (Ye et al, 2017), cAMP signaling pathway (Ravnskjaer et al, 2016), PI3K-Akt signaling pathway (Zhou et al, 2019), MAPK signaling pathway (Yang et al, 2018), Wnt signaling pathway (Yao et al, 2018), NAFLD (Engin, 2017), type 1 diabetes mellitus (Ritchie et al, 2017), cGMP-PKG signaling pathway (Schwarz et al, 2018), FoxO signaling pathway (Cheng and White, 2011), type II diabetes mellitus (Samuel and Shulman, 2012), insulin secretion (Eto et al, 2002), and insulin signaling pathway (Consitt et al, 2009) as shown in Table 1. As hypermethylation in promoter regions is believed to silence the gene expression, it is reasonable to conclude that HG induces metabolic disorders via methylation of their key genes in the pathways, which were confirmed by analysis of mRNA levels as shown in Figure 5.…”

Section: Ll Open Access Isciencementioning

confidence: 99%

High Glucose Induces Lipid Accumulation via 25-Hydroxycholesterol DNA-CpG Methylation

et al. 2020

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This work investigates the relationship between high-glucose (HG) culture, CpG methylation of genes involved in cell signaling pathways, and the regulation of carbohydrate and lipid metabolism in hepatocytes. The results indicate that HG leads to an increase in nuclear 25-hydroxycholesterol (25HC), which specifically activates DNA methyltransferase-1 (DNMT1), and regulates gene expression involved in intracellular lipid metabolism. The results show significant increases in 5m CpG levels in at least 2,225 genes involved in 57 signaling pathways. The hypermethylated genes directly involved in carbohydrate and lipid metabolism are of PI3K, cAMP, insulin, insulin secretion, diabetic, and NAFLD signaling pathways. The studies indicate a close relationship between the increase in nuclear 25HC levels and activation of DNMT1, which may regulate lipid metabolism via DNA CpG methylation. Our results indicate an epigenetic regulation of hepatic cell metabolism that has relevance to some common diseases such as non-alcoholic fatty liver disease and metabolic syndrome.

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Section: Ll Open Access Isciencementioning

confidence: 99%

High Glucose Induces Lipid Accumulation via 25-Hydroxycholesterol DNA-CpG Methylation

et al. 2020

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“…[2][3][4] Besides, the evaluation of long-term outcomes was lacking in these studies. [5][6][7] From the perspective of our study population, patients in weekend group had a worse liver function, higher incidence of cirrhosis, and lower rate of in taking antiviral drugs. It could be the reason why patients in weekend group had a worse OS before PSM.…”

mentioning

confidence: 88%

“…However, the objects of these studies are emergency surgery, the elective hepatectomy has not been discussed [2–4] . Besides, the evaluation of long-term outcomes was lacking in these studies [5–7] . From the perspective of our study population, patients in weekend group had a worse liver function, higher incidence of cirrhosis, and lower rate of in taking antiviral drugs.…”

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confidence: 91%

Safety of elective hepatectomy performed on weekend for patients with hepatocellular carcinoma

Dai

Shen

Zhang

et al. 2021

Chinese Medical Journal

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The incidence of hepatocellular carcinoma (HCC) is increasing year by year. The International Agency for Research on Cancer (IARC) reported that more than 630,000 people were diagnosed with HCC in 2020 and more than half of new cases of HCC were in China. The increasing number of patients overburdens the medical system and the waiting time before the surgery becomes longer and longer. This poses a new challenge to the applicability of traditional surgical management model. The elective surgery performed on weekend could provide an efficient solution to the problem. However, the safety of weekend surgery is controversial because surgical patients have a higher severe complication incidence and postoperative mortality on the weekend compared to the weekday (ie, weekend effect). Glance et al [1] reported that patients in America undergoing moderate-to-high risk surgery on the weekend have a clinically significantly increased risk of death and major complications compared with a similar surgery on a weekday.

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“…Few studies analyzed this "weekday effect" in major abdominal surgery [5][6][7][8][9][10][11][12], and none of them was conducted within a unit with an established ERAS protocol for gastrectomy. A large single-center experience on patients who underwent abdominal surgery did not find any significant difference in mortality and LoS between patients operated early or late during the week [13]. Other studies highlighted how major surgery performed during the second half of the week was burdened by higher postoperative mortality [14][15][16].…”

Section: Introductionmentioning

confidence: 99%

The “Weekday Effect” on Enhanced Recovery after Surgery Protocol for Gastrectomy

Weindelmayer¹,

Mengardo²,

Torroni³

et al. 2023

Dig Surg

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Introduction: While Enhanced Recovery After Surgery (ERAS) protocol demonstrated to improve outcomes after gastrectomy, some papers evidenced a detrimental effect on postoperative morbidity related to the "weekday effect". We aimed to understand whether the day of gastrectomy could affect postoperative outcomes and compliance with ERAS items. Methods: We included all patients that underwent gastrectomy for cancer between January 2017 and September 2021. Cohort was divided considering the day of surgery: Early group (Monday-Wednesday) and Late group (Thursday-Friday). Compliance with protocol and postoperative outcomes were compared. Results: 227 patients were included in Early group, while 154 in Late group. The groups were comparable in pre-operative characteristics. No significant difference in pre/intraoperative and postoperative ERAS items' compliance was apparent between Early and Late groups, with most items exceeding the 70% threshold. Median length of stay was 6.5 days and 6 days in Early and Late groups (p=0.616), respectively. Morbidity was 50% in both groups, with severe complications that occurred in 13% of Early patients and 15% of Late patients. Ninety-day mortality was 2%, and it was similar between the two groups. Conclusions: In a Center with a standardized ERAS protocol, the weekday of gastrectomy has no significant impact on the success of each ERAS item and on postoperative surgical and oncological outcomes.

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The weekday effect on postoperative mortality in elective abdominal surgery: An observational study using propensity score methods

Cited by 6 publications

References 27 publications

High Glucose Induces Lipid Accumulation via 25-Hydroxycholesterol DNA-CpG Methylation

High Glucose Induces Lipid Accumulation via 25-Hydroxycholesterol DNA-CpG Methylation

Safety of elective hepatectomy performed on weekend for patients with hepatocellular carcinoma

The “Weekday Effect” on Enhanced Recovery after Surgery Protocol for Gastrectomy

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