Department of General, Visceral, Transplant, Vascular, and Pediatric Surgery, Center for Operative Medicine, University Hospital of Würzburg, Würzburg, Germany.
Department of Surgery, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany.
Dtsch Arztebl Int. 2020 Aug 3;117(31-32):521-527. doi: 10.3238/arztebl.2020.0521.
A number of studies have revealed higher postoperative mortality after operations that were performed toward the end of the week. It is not yet known whether a day-of-the-week effect exists after visceral surgical procedures for cancer in Germany.
Data on resections of carcinomas of the colon, rectum (2010-2017), and head of the pancreas (2014-2017) (n = 19 703) that had been prospectively acquired by the Study, Documentation, and Quality Center of the German Society for General and Visceral Surgery were analyzed in relation to the day of the week on which the operation was performed. The primary endpoint was postoperative 30-day mortality; the secondary endpoints were complications, length of hospital stay, and MTL30 (a combined outcome criterion that is positive if the patient has died, is still in the hospital, or has been transferred to another acute care hospital 30 days after the index procedure).
Resections of colon carcinomas that were performed on Mondays were associated with more advanced tumor stages (T4: 18.4% vs. 15.7%, p <0.001), higher 30-day mortality (3.5% vs. 2.3%, p = 0.004), and a more frequently positive MTL30 (10.5% vs. 8.5%, p = 0.004). Among patients who underwent pancreatic head resections, those whose procedures were on Tuesday had higher mortality (6.2% vs. 3.8%; p = 0.021). Among those who underwent surgery for rectal carcinoma, the day of the week on which the procedure was performed had no effect on postoperative morality. Multivariate analysis revealed that the independent risk factors for postoperative mortality were colonic resection on a Monday (odds ratio [OR]: 1.45; 95% confidence interval [1.11; 1.92], p = 0.008) and pancreatic head resection on a Tuesday (OR: 1.88 [1.18; 2.91], p = 0.006).
Elective surgery for carcinoma of the colon or pancreatic head is associated with slightly higher mortality if per - formed toward the beginning of the week. On the other hand, the day of the week has no effect on the outcome of surgery for rectal carcinoma.
多项研究表明，在一周接近尾声时进行的手术，术后死亡率更高。目前尚不清楚德国是否存在与癌症内脏手术相关的手术日效应。
对德国普通和内脏外科协会的研究、记录和质量中心前瞻性采集的结肠癌、直肠癌（2010-2017 年）和胰头癌切除术（2014-2017 年）的数据（n=19703），与手术日相关联。主要终点为术后 30 天死亡率；次要终点为并发症、住院时间和 MTL30（如果患者在指数手术后 30 天内死亡、仍在住院或已转移到另一家急性护理医院，则为阳性的综合结果标准）。
周一进行的结肠癌切除术与更晚期的肿瘤分期（T4：18.4%比 15.7%，p<0.001）、更高的 30 天死亡率（3.5%比 2.3%，p=0.004）和更频繁的 MTL30 阳性（10.5%比 8.5%，p=0.004）相关。在接受胰头切除术的患者中，周二进行手术的患者死亡率更高（6.2%比 3.8%；p=0.021）。对于接受直肠癌手术的患者，手术日对术后死亡率没有影响。多变量分析显示，术后死亡率的独立危险因素是周一进行结肠切除术（优势比 [OR]：1.45；95%置信区间 [1.11；1.92]，p=0.008）和周二进行胰头切除术（OR：1.88 [1.18；2.91]，p=0.006）。
如果在一周的早期进行结肠癌或胰头癌的择期手术，死亡率会略高。另一方面，手术日对直肠癌手术的结果没有影响。
