New Study in JNCCN Raises Questions about Resource Availability at Hospitals on Weekends and Holidays

Netherlands-based researchers found emergency colon cancer surgery was more likely to lead to complications if performed on a weekend, rather than a weekday

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National Comprehensive Cancer Network

Jun 21, 2018, 09:31 ET

FORT WASHINGTON, Pa., June 21, 2018 /PRNewswire-USNewswire/ -- The likelihood of severe complications after emergency colon cancer surgery is significantly higher over the weekend, according to a new study in the latest issue of JNCCN – Journal of the National Comprehensive Cancer Network. The research was led by Perla Marang-van de Mheen, PhD, of the Leiden University Medical Centre, Netherlands, and funded by the Dutch Cancer Foundation. The study examined 5,052 patients who underwent emergency colon cancer surgery at any Dutch hospital between 2012 and 2015, plus another 172 emergency rectal cancer surgery recipients. It found, after adjusting for case-mix, that weekend surgeries had a 66% higher mortality rate, and a 29% higher severe complication rate, compared to Monday surgeries.

The researchers used data from the Dutch ColoRectal Audit, which contains a wide range of information on patient and tumor characteristics, treatment, and complications. Planned surgeries were omitted from the study, and weekends were defined as Saturday and Sunday, plus any national holidays. Severe complications were defined as any post-operative complication that led to a hospital stay of more than 14 days or required an additional operation. Of the 5,052 patients who underwent emergency colon cancer surgery during the study's time period, 4,244 (84%) were carried out on a weekday, versus 808 (16%) during the weekend.

The published results include a call for more research, particularly regarding how care is organized across various hospitals during the weekend, not just for the pre-operative period, but also for post-operative care. These results are probably due to "a far more complex interplay between different factors, regarding both the patient and the organization, rather than simply the day of the initial surgery itself," said Dr. Marang-van De Mheen.

"Allocating appropriate resources during weekends and holidays is critical to achieving outcomes that are just as good on the weekends as they are during the workweek," said Steven Nurkin, MD, MS, FACS, Associate Professor in the Department of Surgical Oncology, Roswell Park Comprehensive Cancer Center. Dr. Nurkin is a member of the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines^®) Panel for Colorectal Cancers. "The authors should be commended on a very timely study. These results are concerning, and need to be seriously considered. However, I think we need to be careful in extrapolating just from this study that surgical patients have significantly worse outcomes on the weekends. The weekend on-call teams are there for those true emergencies, and the 'urgent, but not emergent' surgeries may be delayed until the early workweek. Those that get operated on during weekends are frequently 'the sickest of the sick' and are therefore at higher risk of complications and worse outcomes."

"Regardless of whether surgery takes place on a weekend or during the week, it's always important for patients to report any symptoms right away, to make sure that hospital staff has all the relevant information needed to catch complications early on," concluded Dr. Marang-van De Mheen.

To read the entire study, visit JNCCN.org. Complimentary access to "Weekend Effect in Emergency Colon and Rectal Cancer Surgery: A Prospective Study Using Data From the Dutch ColoRectal Audit" is available until August 10, 2018.

About JNCCN—Journal of the National Comprehensive Cancer Network
More than 25,000 oncologists and other cancer care professionals across the United States read JNCCN—Journal of the National Comprehensive Cancer Network. This peer-reviewed, indexed medical journal provides the latest information about best clinical practices, health services research, and translational medicine. JNCCN features updates on the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines^®), review articles elaborating on guidelines recommendations, health services research, and case reports highlighting molecular insights in patient care. JNCCN is published by Harborside Press. Visit JNCCN.org. To inquire if you are eligible for a FREE subscription to JNCCN, visit http://www.nccn.org/jnccn/subscribe.asp. Follow JNCCN on Twitter @JNCCN.

About the National Comprehensive Cancer Network
The National Comprehensive Cancer Network^® (NCCN^®), a not-for-profit alliance of 27 leading cancer centers devoted to patient care, research, and education, is dedicated to improving the quality, effectiveness, and efficiency of cancer care so that patients can live better lives. Through the leadership and expertise of clinical professionals at NCCN Member Institutions, NCCN develops resources that present valuable information to the numerous stakeholders in the health care delivery system. As the arbiter of high-quality cancer care, NCCN promotes the importance of continuous quality improvement and recognizes the significance of creating clinical practice guidelines appropriate for use by patients, clinicians, and other health care decision-makers.

The NCCN Member Institutions are: Fred & Pamela Buffett Cancer Center, Omaha, NE; Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; City of Hope Comprehensive Cancer Center, Los Angeles, CA; Dana-Farber/Brigham and Women's Cancer Center | Massachusetts General Hospital Cancer Center, Boston, MA; Duke Cancer Institute, Durham, NC; Fox Chase Cancer Center, Philadelphia, PA; Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance, Seattle, WA; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Mayo Clinic Cancer Center, Phoenix/Scottsdale, AZ, Jacksonville, FL, and Rochester, MN; Memorial Sloan Kettering Cancer Center, New York, NY; Moffitt Cancer Center, Tampa, FL; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute, Columbus, OH; Roswell Park Comprehensive Cancer Center, Buffalo, NY; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center, Memphis, TN; Stanford Cancer Institute, Stanford, CA; University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL; UC San Diego Moores Cancer Center, La Jolla, CA; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; University of Colorado Cancer Center, Aurora, CO; University of Michigan Rogel Cancer Center, Ann Arbor, MI; The University of Texas MD Anderson Cancer Center, Houston, TX; University of Wisconsin Carbone Cancer Center, Madison, WI; Vanderbilt-Ingram Cancer Center, Nashville, TN; and Yale Cancer Center/Smilow Cancer Hospital, New Haven, CT.