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Swinton M, Mariam NBG, Tan JL, Murphy K, Elumalai T, Soni M, Ferrera A, Richardson C, Walshaw R, Mistry H, Ramani V, Song Y, Birtle A, Henry A, Chan J, Hoskin P, Choudhury A. Bladder-Sparing Treatment With Radical Dose Radiotherapy Is an Effective Alternative to Radical Cystectomy in Patients With Clinically Node-Positive Nonmetastatic Bladder Cancer. J Clin Oncol 2023; 41:4406-4415. [PMID: 37478391 DOI: 10.1200/jco.23.00725] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/10/2023] [Accepted: 06/08/2023] [Indexed: 07/23/2023] Open
Abstract
PURPOSE Bladder-sparing trimodal therapy (TMT) is an alternative to radical cystectomy (RC) according to international guidelines. However, there are limited data to guide management of nonmetastatic clinically node-positive bladder cancer (cN+ M0 BCa). We performed a multicenter retrospective analysis of survival outcomes in node-positive patients to inform practice. METHODS Data from patients diagnosed with cN+ M0 BCa were collected from participating UK Oncology centers offering both TMT and RC. Overall survival (OS) and progression-free survival (PFS) outcomes were collected with details of treatment and clinical factors. RESULTS A total of 287 patients with cN+ M0 BCa were included in the survival analysis. Median OS across all patients was 1.55 years (95% CI, 1.35 to 1.82 years). Receiving radical treatments was associated with improved OS (hazard ratio [HR], 0.32; 95% CI, 0.23 to 0.44; P < .001) compared with receiving palliative treatment. Radically treated patients (n = 163) received RC (n = 76) or radical dose radiotherapy (RT, n = 87); choice of radical treatment showed no association with OS (HR, 0.94; 95% CI, 0.63 to 1.41; P = .76) or PFS (HR, 0.74; 95% CI, 0.50 to 1.08; P = .12) on multivariable analysis. CONCLUSION Patient cohorts with cN+ M0 BCa had equivalent survival outcomes whether treated with surgery or radical RT. Given the known morbidities of RC-in a patient group with poor survival-this study confirms that bladder-sparing TMT treatment should be a treatment option available to all patients with cN+ M0 BCa.
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Affiliation(s)
- Martin Swinton
- Christie Hospital NHS Foundation Trust, Manchester, United Kingdom
- Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, United Kingdom
| | | | - Jean Ling Tan
- Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, United Kingdom
| | - Katherine Murphy
- Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, United Kingdom
| | - Thiraviyam Elumalai
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Manjusha Soni
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | | | | | - Richard Walshaw
- Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, United Kingdom
| | - Hitesh Mistry
- Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, United Kingdom
| | - Vijay Ramani
- Christie Hospital NHS Foundation Trust, Manchester, United Kingdom
| | - Yeepei Song
- Christie Hospital NHS Foundation Trust, Manchester, United Kingdom
| | - Alison Birtle
- Rosemere Cancer Centre, Royal Preston Hospital, Preston, United Kingdom
| | - Ann Henry
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Joachim Chan
- Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, United Kingdom
| | - Peter Hoskin
- Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, United Kingdom
| | - Ananya Choudhury
- Christie Hospital NHS Foundation Trust, Manchester, United Kingdom
- Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, United Kingdom
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Elumalai T, Maitre P, Portner R, Billy Graham Mariam N, Young T, Hughes S, Wickramasinghe K, Bhana R, Sabar M, Thippu Jayaprakash K, Mistry H, Hoskin P, Choudhury A. Impact of prostate radiotherapy on survival outcomes in clinically node-positive prostate cancer: A multicentre retrospective analysis. Radiother Oncol 2023; 186:109746. [PMID: 37330057 DOI: 10.1016/j.radonc.2023.109746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 06/06/2023] [Accepted: 06/08/2023] [Indexed: 06/19/2023]
Abstract
PURPOSE To evaluate clinical outcomes for cN1M0 prostate cancer treated with varied modalities. MATERIALS AND METHODS Men with radiological stage cN1M0 prostate cancer on conventional imaging, treated from 2011-2019 with various modalities across four centres in the UK were included. Demographics, tumour grade and stage, and treatment details were collected. Biochemical and radiological progression-free survival (bPFS, rPFS) and overall survival (OS) were estimated using Kaplan Meier analyses. Potential factors impacting survival were tested with univariable log-rank test and multivariable Cox-proportional hazards model. RESULTS Total 337 men with cN1M0 prostate cancer were included, 47% having Gleason grade group 5 disease. Treatment modalities included androgen deprivation therapy (ADT) in 98.9% men, either alone (19%) or in combinations including prostate radiotherapy (70%), pelvic nodal radiotherapy (38%), docetaxel (22%), or surgery (7%). At median follow up of 50 months, 5-year bPFS, rPFS, and OS were 62.7%, 71.0%, and 75.8% respectively. Prostate radiotherapy was associated with significantly higher bPFS (74.1% vs 34.2%), rPFS (80.7% vs 44.3%) and OS (86.7% vs 56.2%) at five years (log rank p < 0.001 each). On multivariable analysis including age, Gleason grade group, tumour stage, ADT duration, docetaxel, and nodal radiotherapy, benefit of prostate radiotherapy persisted for bPFS [HR 0.33 (95% CI 0.18-0.62)], rPFS [HR 0.25 (0.12-0.51)], and OS [HR 0.27 (0.13-0.58)] (p < 0.001 each). Impact of nodal radiotherapy or docetaxel was not established due to small subgroups. CONCLUSION Addition of prostate radiotherapy to ADT in cN1M0 prostate cancer yielded improved disease control and overall survival independent of other tumour and treatment factors.
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Affiliation(s)
- Thiraviyam Elumalai
- The Christie NHS Foundation Trust, Manchester, UK; Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
| | | | - Robin Portner
- The Christie NHS Foundation Trust, Manchester, UK; Royal Preston Hospital, Preston, UK
| | | | - Tom Young
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Simon Hughes
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | | | - Muhammad Sabar
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | | | - Peter Hoskin
- The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, University of Manchester, Manchester, UK; Mount Vernon Cancer Centre, Northwood, UK
| | - Ananya Choudhury
- The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, University of Manchester, Manchester, UK; Manchester Biomedical Research Centre, Manchester, UK.
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Mariam NBG, Dunnett-Kane V, Herdman MT, Seers T, Aldcroft D, Balasegaram S, Davenport R, Redmond A, Ng C, Wentworth L. Experience of using a regional network of hospitals in the care of older inpatients with COVID-19 in spring 2020. Future Healthc J 2022; 9:45-50. [DOI: 10.7861/fhj.2021-0104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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4
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Mariam NBG, Song YP, Joseph N, Hoskin P, Reeves K, Porta N, James N, Choudhury A. Hypofractionation: less is more? Oncotarget 2021; 12:1729-1733. [PMID: 34434502 PMCID: PMC8378765 DOI: 10.18632/oncotarget.28023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 06/21/2021] [Indexed: 12/03/2022] Open
Abstract
One third of patients with bladder cancer present with muscle invasive bladder cancer (MIBC) which has a poor prognosis. International guidelines for the management of MIBC recommend radical cystectomy or bladder-preserving treatment based on radical radiotherapy with a form of radiosensitisation. In the UK, both conventional fractionation with 64 Gy in 32 fractions and hypofractionation with 55 Gy in 20 fractions are standard of care options with the choice varying between centres. A meta-analysis of individual patients with locally advanced bladder cancer from two UK multicentre phase 3 trials was published recently. This study evaluated the non-inferiority of a hypofractionated schedule compared to a conventional regime. This analysis confirmed the non-inferiority of the hypofractionated regimen, and noted superior locoregional control. We discuss the relevance of these findings to current practice while considering the radiobiology of hypofractionation, the role of systemic therapies and radiosensitisation, as well as the socioeconomic benefits.
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Affiliation(s)
| | - Yee Pei Song
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | | | - Peter Hoskin
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Mount Vernon Cancer Centre, Northwood, UK
| | - Kimberley Reeves
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Nuria Porta
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - Nicholas James
- Prostate and Bladder Cancer Research Team, The Institute of Cancer Research, London, UK
| | - Ananya Choudhury
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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5
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Hapuarachi BS, Lee R, Khan A, Woodhouse L, Kounnis V, Britton F, Coyle J, Connors K, Billy Graham Mariam N, Weaver J, Waddell T, Hubner R, Kamposioras K, Mansoor W. Real-world data (RWD) reveals benefit for adjuvant chemotherapy with docetaxel, oxaliplatin and fluorouracil/leucovorin (FLOT) is limited to those with tumour regression grade (TRG) ≥3 in oesophago-gastric cancer (OGC). J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.4039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4039 Background: Despite potentially curative surgery, long-term survival from OGC remains poor due to high relapse rate. Neoadjuvant (naFLOT) and adjuvant (aFLOT) FLOT is currently standard treatment for resectable OGC based on data from the FLOT-4 trial. We explored whether TRG was associated with FLOT-outcome using RWD. Methods: Pts with OGC treated with naFLOT +/- aFLOT at a tertiary UK centre were identified following institutional board approval. Clinical and laboratory data were extracted from the patient record. TRG was evaluated by a histopathologist. Median overall survival (OS) and median progression-free survival (PFS) were evaluated using Kaplan-Meier and Log-rank tests; time taken from start of naFLOT, and associations between factors with Fisher’s exact (FE) test. Results: 171 pts were identified, median FU 30 mths. 144 (84%) male; median age 66 (32-84); oesophagus 66 (38%), junctional (GOJ) 73 (43%), gastric 32 (19%); stage IB 3 (2%), stage IIB 26 (15%), stage III 91 (53%), stage IVA 47 (28%) and unknown 4 (2%). Pts had median of 2 comorbidities (range 0-6); performance status (PS) 0: 95 (56%), PS 1: 71 (41%), PS 2: 3 (2%) and PS unknown 2 (1%). 132/171 pts completed 4 cycles of naFLOT and this was significantly associated with undergoing surgery (p = 0.02). Those who had surgery (140/171) had significantly improved PFS (not reached (NR) vs. 6 mths; 95% CI 2-10; p < 0.001) and OS (NR vs. 12 mths; 95% CI 6-18; p < 0.001). TRG was reported for 126/140 patients who underwent surgery. TRG 1/2 (42/126) vs. TRG ≥3 was significantly associated with improved PFS (NR vs. 35 mths; 95% CI NR; p < 0.001) and OS (median NR either group; p < 0.001). Pts with TRG 1/2 who commenced aFLOT (≥1 cycle; n = 31/42) or completed 4 cycles of aFLOT (17/31) did not have improved PFS or OS vs. those who did not. Those with TRG ≥3 who commenced aFLOT (≥1 cycle; n = 62/85) had improved PFS (median NR vs. 22 mths; 95% CI 13-31 p = 0.006) and OS (median NR vs. 25 mths; 95% CI 18-32 p = 0.019). Those with TRG ≥3 who completed 4 cycles of aFLOT (n = 38/62) had significantly improved PFS (median NR vs. 25 mths; 95% CI 14-36 p = 0.016) and OS (median NR vs. 36 mths; 95% CI 16-55 p = 0.012). There was no difference in PFS or OS in pts with TRG ≥3 who had a dose reduction at any time during aFLOT. Conclusions: TRG is a predictor of outcome following naFLOT + surgery with superior outcomes in those with TRG 1/2. Our analyses suggest that only pts with TRG >3 following naFLOT + surgery benefit from adjuvant FLOT. Prospective randomised studies are required to confirm whether pts with TRG 1/2 require treatment with aFLOT.
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Affiliation(s)
| | - Rebecca Lee
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Adeel Khan
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | | | | | - Fiona Britton
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Jessica Coyle
- Christie NHS Foundation Trust, Manchester, United Kingdom
| | | | | | - Jamie Weaver
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Tom Waddell
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Richard Hubner
- Christie NHS Foundation Trust, Manchester, United Kingdom
| | | | - Wasat Mansoor
- The Christie NHS Foundation Trust, Manchester, United Kingdom
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Abdul Rahman R, Billy Graham Mariam N, Mistry H, Aruketty S, Church M, Adamson-Raieste A, Scott JA, Thistlethwaite F, Krebs M, Carter L, Graham DM, Cook N. Differential response rates in early-phase cancer clinical trials (EPCCT). J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.3133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
3133 Background: The primary objective of EPCCT (phase I and non-randomised phase II trials) is to determine the safety and tolerability of new therapeutic agents. Response rates (RR) in these trials have typically been reported at around 10-15%. Increasingly RR and survival outcomes are now investigated in EPCCT as primary or secondary objectives. Methods: Retrospective data analysis was performed on patients (pts) enrolled onto an EPCCT between January 2018 and December 2019 at The Christie NHS Foundation Trust, UK. Data on demographics, prior systemic treatment, sites of disease, performance status, comorbidities, types of therapy, RR, progression free survival (PFS), and overall survival (OS) were collected. Statistical analyses were performed with univariable and multivariable models. Objective response rate (ORR) was defined as the proportion of pts with complete response (CR) and partial response (PR). Duration of response (DOR) was from initial response to progressive disease (PD). Disease control rate (DCR) was defined as CR+PR+ stable disease (SD). Results: A total of 247 pts were treated across 46 EPCCTs. Median age 61 years; 57% female. Sixty-six percent of pts had ≥2 lines of treatment and the majority were ECOG PS 0/1 (98%). Eighty-one percent of pts had ≥2 sites of metastatic disease, and 13 major tumour types were included. Monotherapy trials (159 pts) were predominantly targeted therapies (TT; 60%), or immunotherapies (IO; 20%). Combination therapy trials (88 pts) were TT-based (68%) or IO-based (32%). Data for RR analyses was available for 231 pts. ORR across all trials was 15% (CR 2%) and DCR was 63%. The median DOR was 8.3 months (mos) (95% CI: 7.0 – 9.7) with 28% of pts responding for >6 mos and 7% for >12 mos. ORR in pooled IO treated pts was 27%, DCR was 65% with sustained response >6 mos seen in 37% of these pts. ORR in pooled TT treated pts was 9.4%, DCR was 60% and sustained response > 6 mos seen in 25% of pts. ORR for IO v TT treated pts was significantly different, p=0.007 (pearson chi square), but no significant difference was seen for DCR. Median PFS for all patients was 5.0 mos (95% CI: 4.1 – 6.0) and OS was 10.4 mos (95% CI: 8.4 – 13.0). OS for those with a PR is not reached (HR for PR v PD, 0.006 (95% CI: 0.002 – 0.18). Pts with SD appear to have significantly better OS compared to those with PD (14.6 v 4.2 mos, HR 0.2 (95% CI: 0.1 – 0.3). Multivariable Cox proportional hazards analysis for OS was significant for male gender (HR 1.9, p=0.002), presence of liver metastasis (HR 2.0, p=0.001), low Hb (HR 0.8, p=0.03) and log (LDH) (HR 1.9, p<0.001). Conclusions: Two-thirds of pts enrolled on EPCCTs benefitted in terms of DCR with significant OS improvement in those with PR and SD. Higher ORR were seen in pts receiving IO-based treatments however DCR was similar in IO and TT pts. Gender, presence of liver metastases, Hb count and LDH level contributed significantly to survival differences.
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Affiliation(s)
| | | | - Hitesh Mistry
- The University of Manchester, Manchester, United Kingdom
| | - Sreeja Aruketty
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Matt Church
- Christie Hospital, Manchester, United Kingdom
| | | | | | - Fiona Thistlethwaite
- The Christie NHS Foundation Trust and University of Manchester, Manchester, United Kingdom
| | - Matthew Krebs
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester and The Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Louise Carter
- The Christie NHS Foundation Trust and The University of Manchester, Manchester, United Kingdom
| | - Donna M. Graham
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Natalie Cook
- The Christie NHS Foundation Trust and The University of Manchester, Manchester, United Kingdom
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7
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Sadat U, Mariam NBG, Usman A, Chowdhury MM, El Nakhal T, DaCosta OF, Gillard JH, Hayes PD, Varty K. Association Between Abdominal Visceral Artery Calcification and All-Cause Mortality-A Computerized Tomography Imaging-Based Longitudinal Follow-Up Study. Angiology 2019; 70:237-243. [PMID: 30180770 DOI: 10.1177/0003319718796889] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Arterial calcification in different arterial beds has been observed to be an independent predictor of mortality. The association of abdominal visceral artery calcium with all-cause mortality remains unexplored. Patients who had undergone contrast-enhanced computerized tomography (CT) imaging for routine assessment of peripheral arterial disease (PAD) were considered for this study. A novel calcium score (abdominal visceral arteries calcium [AVAC]) for the abdominal visceral arteries (celiac axis, superior mesenteric, and renal arteries) was calculated using a modified Agatston score. Cumulative AVAC was defined as sum total of the calcium score of above individual arteries. The primary outcome was all-cause mortality. The association of AVAC with all-cause mortality was assessed. Of the 134 consecutive patients, 89 were included for analysis. Median follow-up duration was 72 (47-91) months since CT imaging; 35 (39%) patients died during this period. Hypertension and cumulative AVAC score had a significant association with all-cause mortality (P < .05). Cumulative visceral abdominal artery calcification is associated with all-cause mortality in patients with PAD. Future prospective studies are warranted to investigate this relationship in PAD and other patient cohorts.
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Affiliation(s)
- Umar Sadat
- Cambridge Vascular Unit, Addenbrooke's Hospital, Cambridge, United Kingdom.,University of Cambridge, Cambridge, United Kingdom
| | | | - Ammara Usman
- University of Cambridge, Cambridge, United Kingdom.,University Department of Radiology, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Mohammed M Chowdhury
- Cambridge Vascular Unit, Addenbrooke's Hospital, Cambridge, United Kingdom.,University of Cambridge, Cambridge, United Kingdom
| | - Tamer El Nakhal
- Cambridge Vascular Unit, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Olga Fadeeva DaCosta
- Imaging Clinical Imaging Facility, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Jonathan H Gillard
- University of Cambridge, Cambridge, United Kingdom.,University Department of Radiology, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Paul D Hayes
- Cambridge Vascular Unit, Addenbrooke's Hospital, Cambridge, United Kingdom.,University of Cambridge, Cambridge, United Kingdom
| | - Kevin Varty
- Cambridge Vascular Unit, Addenbrooke's Hospital, Cambridge, United Kingdom
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8
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Ambler GK, Mariam NBG, Sadat U, Coughlin PA, Loftus IM, Boyle JR. Weekend effect in non-elective abdominal aortic aneurysm repair. BJS Open 2017; 1:158-164. [PMID: 29951618 PMCID: PMC5989979 DOI: 10.1002/bjs5.24] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Accepted: 09/14/2017] [Indexed: 11/11/2022] Open
Abstract
Background The ‘weekend effect’ describes the phenomenon where patient outcomes appear worse for those admitted at the weekend. It has been used recently to justify significant changes in UK health policy. Recent evidence has suggested that the effect may be due to a combination of inadequate correction for confounding factors and inaccurate coding. The effects of these factors were investigated in patients with acute abdominal aortic aneurysm (AAA). Methods Patients undergoing non‐elective AAA repair entered into the UK National Vascular Registry from January 2013 until December 2015 were included in a case–control study. The patients were divided according to whether they were treated during the week (Monday 08.00 hours to Friday 17.00 hours) or at the weekend. Data extracted included demographics, co‐morbidities, preoperative medications and baseline blood test results, as well as outcomes. Coding issues were investigated by looking at patients treated for ruptured, symptomatic or asymptomatic AAA within the non‐elective cohort. The primary outcome was in‐hospital mortality. Secondary outcomes included length of inpatient stay, and cardiac, respiratory and renal complications. Results The mortality rate appeared to be higher at the weekend (odds ratio (OR) 1·69, 95 per cent c.i. 1·47 to 1·94; P < 0·001), but this effect disappeared when confounding factors and coding issues were corrected for (corrected OR for ruptured AAA 1·09, 0·92 to 1·29; P = 0·330). Differences in outcomes were similar for prolonged length of hospital stay (uncorrected OR 1·21, 95 per cent c.i. 1·06 to 1·37, P = 0·005; corrected OR for ruptured AAA 1·06, 0·91 to 1·10, P = 0·478), and morbidity outcomes. Conclusion After appropriate correction for confounding factors and coding effects, there was no evidence of a significant weekend effect in the treatment of non‐elective AAA in the UK.
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Affiliation(s)
- G K Ambler
- Division of Population Medicine Cardiff University Cardiff UK.,South East Wales Vascular Network, Aneurin Bevan University Health Board, Royal Gwent Hospital Newport UK
| | - N B G Mariam
- Cambridge Vascular Unit, Cambridge University Hospitals NHS Foundation Trust Cambridge UK
| | - U Sadat
- Cambridge Vascular Unit, Cambridge University Hospitals NHS Foundation Trust Cambridge UK
| | - P A Coughlin
- Cambridge Vascular Unit, Cambridge University Hospitals NHS Foundation Trust Cambridge UK
| | - I M Loftus
- Saint George's Vascular Institute University of London London UK
| | - J R Boyle
- Cambridge Vascular Unit, Cambridge University Hospitals NHS Foundation Trust Cambridge UK
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