Department of Thoracic Surgery, Chang Gung Memorial Hospital-Linkou, Chang Gung University, Taoyüan, Taiwan.
Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Taoyüan, Taiwan.
Ann Surg Oncol. 2023 Jun;30(6):3790-3798. doi: 10.1245/s10434-023-13280-2. Epub 2023 Feb 24.
We examined the impact of the weekend effect on the survival outcomes of patients undergoing elective esophagectomy for cancer.
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.
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).
Elective esophagectomy for cancer during weekends has an adverse impact on short- and long-term survival.
本研究旨在探讨择期食管癌根治术患者的“周末效应”对其生存结局的影响。
本研究为回顾性分析，纳入了台湾地区 2008 年至 2015 年期间在医院接受择期食管癌根治术的所有患者（n=3235）。根据手术日将患者分为两组：手术日为周一至周五的患者（工作日组，n=3148）；手术日为周六或周日的患者（周末组，n=87）。采用倾向评分的逆概率治疗加权法（inverse probability of treatment weighting，IPTW）来校正由于基线差异导致的选择偏倚。
校正混杂因素后，周末手术与较高的 90 天死亡率独立相关（10.5%比 5.5%，P<0.001）。术后 2 年，周末手术仍是总体生存的独立不良预测因素（风险比[hazard ratio，HR]为 1.38，P<0.001）。重要的是，周末手术的不利结局在某些亚组中更为明显，包括年龄>60 岁（HR=1.61，P<0.001）、合并症负担较高（HR=1.32，P<0.001）、肿瘤分期较晚（HR=1.50，P<0.001）、组织学诊断为鳞状细胞癌（HR=1.20，P<0.001）以及接受微创食管切除术（HR=1.26，P<0.001）的患者。
择期食管癌根治术在周末进行会对短期和长期生存产生不利影响。
