Weekday of gastrectomy and long-term survival in gastric adenocarcinoma

Weekday effect of surgery on in-hospital outcome in pancreatic surgery: a population-based study

IMPORTANCE

There is conflicting evidence regarding weekday dependent outcome in complex abdominal surgery, including pancreatic resections.

OBJECTIVE

To clarify weekday-dependency of outcome after pancreatic resections in a comprehensive nationwide context.

DESIGN

Retrospective cross-sectional study of anonymized nationwide hospital billing data (DRG data).

SETTING

Germany between 2010 and 2020. PARTICIPANTS AND EXPOSURE: all patient records with a procedural code for a pancreatic resection.

MAIN OUTCOME AND MEASURES

Primary endpoint was complication occurrence and failure to rescue, i.e. mortality in case of complications, by weekday of index surgery.

RESULTS

94,661 patient records with a pancreatic resection were analyzed, of whom 45.2% were female. Mean age was 65.3 years. In 46.3% of all patient records, the main diagnosis was pancreatic carcinoma. The most common index surgery was pancreaticoduodenectomy (61.2%). Occurrence of at least one of predefined complications was 67.6% (64,029 cases) and was highest following a Monday index surgery. In-hospital mortality in case of at least one complication, i.e. failure to rescue (FtR), accounted for 8,040 deaths (97.7% of 8,228 total deaths, 12.6% FtR, 8.7% in-hospital mortality). FtR was highest (13.1%) following a Monday index surgery and lowest (11.8%) after a Thursday index surgery. Overall in-hospital mortality followed the same trend as FtR. In a multivariable logistic regression, in the overall cohort, in addition to increased age, frailty, male sex, benign entities, and total pancreatectomy performance, Wednesday (adjusted Odd's Ratio, OR, 0.92, 95% Confidence Interval, CI, 0.85-0.99) and Thursday (adjusted OR, 0.89, CI, 0.82-0.96) index surgeries were associated with lower FtR in reference to Monday. Stratified by patient volume, complication occurrence and FtR was only dependent of the weekday of index surgery in low volume hospitals.

CONCLUSIONS AND RELEVANCE

Pancreatic resections are complex procedures with high complication rates and FtR, resulting in high in-hospital mortality. Complication occurrence and FtR is dependent on the weekday of index surgery and mediates the same distribution pattern for overall in-hospital mortality. Stratified by patient volume, this weekday dependency of the index surgery on complication occurrence and FtR was only observed in low volume hospitals.

Impact of weekday of esophageal cancer surgery on long-term oncological outcomes

BACKGROUND

Studies about the influence of weekday of esophagectomy on survival are limited and show conflicting results. This study aimed to explore whether weekday of esophagectomy affects patient's survival outcomes.

METHODS

Patients who underwent esophagectomy in a grade-A tertiary hospital from January 2015 to December 2016 were enrolled. The primary outcome was 5-year overall survival (OS). The secondary outcomes were 5-year disease-free survival (DFS) and days of hospitalization. The impact of weekday surgery on 5-year OS and DFS were evaluated with Cox regression, and impact on days of hospitalization was assessed using logistic regression. Propensity score matching (PSM) analysis was used to balance the confounding factors.

RESULTS

A total of 1478 patients were included. The 5-year OS and DFS were 63.77% and 59.26% respectively. Multivariate analyses adjusted for covariables indicated that weekday was not significantly associated with OS (P = 0.076), nor days of hospitalization (P = 0.824), but it appeared to be associated with DFS (P = 0.044). Additionally, PSM analysis showed no significant effect of weekday on the 5-year OS, nor DFS and days of hospitalization.

CONCLUSION

In patients diagnosed with squamous esophageal cancer, the survival outcome of patients was not influenced by weekday.