Impact of Weekend Effect on Short- and Long-Term Survival of Patients Undergoing Esophagectomy for Cancer: A Population-Based, Inverse Probability of Treatment-Weighted Analysis

• Published in: Annals of surgical oncology Vol. 30; no. 6; pp. 3790 - 3798
• Main Authors: Yang, Tzu-Yi, Wen, Yu-Wen, Chao, Yin-Kai
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.06.2023; Springer Nature B.V
• Subjects: Cancer; Carcinoma, Squamous Cell - surgery; Comorbidity; Esophageal Neoplasms - pathology; Esophageal Neoplasms - surgery; Esophagectomy; Humans; Medicine; Medicine & Public Health; Oncology; Patients; Propensity Score; Proportional Hazards Models; Retrospective Studies; Squamous cell carcinoma; Surgery; Surgical Oncology; Thoracic Oncology; Treatment Outcome
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-023-13280-2

Background We examined the impact of the weekend effect on the survival outcomes of patients undergoing elective esophagectomy for cancer. Methods This was a retrospective analysis of a nationwide, health administrative dataset that included all patients ( n = 3235) who had undergone elective esophagectomy for cancer in Taiwanese hospitals between 2008 and 2015. Patients were categorized according to the day of surgery (weekday group: surgical procedures starting Monday through Friday, n = 3148; weekend group: surgical procedures starting on Saturday or Sunday, n = 87). Inverse probability of treatment weighting (IPTW) using the propensity score was used to account for selection bias due to baseline differences. Results After IPTW, patients undergoing esophagectomy on weekends had a higher 90-days mortality rate compared with those undergoing surgery on a weekday (10.5% vs. 5.5%, respectively, P < 0.001). After controlling for potential confounders, weekend surgery was identified as an independent adverse predictor of 2-years, overall survival [hazard ratio (HR) = 1.38, P < 0.001]. Importantly, inferior weekend outcomes were especially evident in certain subgroups, including patients aged > 60 years (HR = 1.61, P < 0.001), as well as those with a high burden of comorbidities (HR = 1.32, P < 0.001), advanced tumor stage (HR = 1.50, P < 0.001), histological diagnosis of squamous cell carcinoma (HR = 1.20, P < 0.001), and treated with minimally invasive esophagectomy (HR = 1.26, P < 0.001). Conclusions Elective esophagectomy for cancer during weekends has an adverse impact on short- and long-term survival.