B-002ALSO IN THE NETHERLANDS INCREASED POSTOPERATIVE MORTALITY AFTER LUNG CANCER SURGERY ON FRIDAYS

• Published in: Interactive cardiovascular and thoracic surgery 2014-06, Vol.18 (suppl_1), p.S1-S1
• Main Authors: Plaisier, Peter, Maat, A., Damhuis, R.
• Format: Article
• Language: English
• ISSN: 1569-9293; 1569-9285
• DOI: 10.1093/icvts/ivu167.2

Objectives: A recent study reported on the association between postoperative mortality [POM] and the day of week of elective surgical procedures [BMJ 2013;346:f2424]. For lung surgery, POM was significantly increased as soon as procedures were carried out on Fridays (odds ratio: 1.75). The aim of this study was to investigate whether this finding would also apply to the Netherlands. Methods: Data were retrieved from the Dutch National Cancer Registry regarding patients operated for primary non-small-cell carcinoma during the period 2005-2010. Excluded were children, patients diagnosed in our country but operated abroad, and non-anatomical resections. POM was defined as death within 30 days after operation independent of cause of death or hospital discharge. Using multivariate logistic regression, a prediction model was developed based on the variables age, sex, type of operation and period. This case-mix model was applied to examine the day of the week of operation, hospital volume and surgical technique (VATS versus open). Results: The series comprised 9579 patients (37% female, 63% male) with 36% ≥70 years. Overall POM was 2.7%, declining from 3.3% in 2005-2007 to 2.1% in 2008-2010; the proportion of pneumonectomies dropped from 17 to 12%. POM increased with age and was higher for men. Hospital volume (P = 0.57) and surgical technique (P = 0.24) were not of prognostic significance. POM for operations on Monday to Thursday (85%) was 2.5% against 4.0% for operations on Fridays (13%). This difference remained significant after correction for case mix (odds ratio: 1.59; 95% confidence interval: 1.14-2.21). POM for urgent (i.e. non-elective) operations during the weekend (2%) was 6.8%. Conclusions: This study confirms increased POM for lung cancer surgery performed on Fridays. Since the underlying cause could not be determined from our data, clinical audits are needed to investigate our hypothesis that this phenomenon is caused by limited staffing during weekends prohibiting early detection and adequate management of complications. Disclosure: No significant relationships.