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

Abstract

Background: For most solid cancers, surgery represents the mainstay of curative treatment. Several studies investigating the effects of the weekday of surgery (WOS) on patient outcomes have yielded conflicting results. Barmer, the second-largest health insurance company in Germany, serves roughly 10% of the German population. We have used the Barmer database to evaluate how the weekday on which the surgery is performed influences long-term oncologic outcomes. Methods: For this retrospective cohort study, the Barmer database was used to investigate the effect of the WOS (Monday–Friday) on outcomes following oncological resections of the colorectum (n=49,003), liver (n=1,302), stomach (n=5027), esophagus (n=1126), and pancreas (n=6,097). In total, 62,555 cases from 2008 to 2018 were included in the analysis. The endpoints were overall survival (OS), postoperative complications, and necessity for therapeutic interventions or re-operations. We furthermore examined whether the annual caseload or certification as a cancer center influenced the weekday effect. Results: We observed a significantly impaired OS for patients receiving gastric or colorectal resections on a Monday. Colorectal surgery performed on Mondays was associated with more postoperative complications and higher probability of re-operations. The annual caseload or a certification as a colorectal cancer center had no bearing on the observed weekday effect. There is evidence that hospitals schedule older patients with more comorbidities earlier in the week, possibly explaining these findings. Conclusion: This is the first study investigating the influence of the WOS on long-term survival in Germany. Our findings indicate that, in the German healthcare system, patients undergoing colorectal cancer surgery on Mondays have more postoperative complications and, therefore, require significantly more re-operations, ultimately lowering OS. This surprising finding appears to reflect an attempt to schedule patients with higher postoperative risk earlier in the week as well as semi-elective patients admitted on weekends scheduled for surgery on the next Monday.

Pediatric kidney transplantation: is it safe to perform during night-time or day-off?

“…Furthermore, even though the weekend effect did not seem to impact on the outcomes of KTs in adult population [ 19 ], no data were available for children. For this reason, the study assessed the influence of the incision time and the calendar on the rate of adverse events, as already described for complex abdominal surgery in adult populations [ 11 , 12 ].…”

“…Even though the effects of surgeon’s fatigue are difficult to assess in real-life [ 10 ], reports from urgent and elective abdominal surgery in the adult populations found higher rate of mortality or complications during or immediately after weekends [ 11 , 12 ]. We, therefore, hypothesized that the fatigue of ordinary working days could also impact the outcomes of the pediatric KTs performed during days-off.…”