Surgery during holiday periods and prognosis in oesophageal cancer: A population-based nationwide Swedish cohort study

Abstract

Objective: Previous studies indicate an increased short-term and long-term mortality from major cancer surgery performed towards the end of the working week or during the weekend. We hypothesised that the prognosis after major cancer surgery is also negatively influenced by surgery conducted during holiday periods. Setting: Population-based nationwide Swedish cohort study. Participants: Patients undergoing oesophagectomy for oesophageal cancer between 1987 and 2010. Among 1820 included patients, 206 (11.3%) and 373 (20.5%) patients were operated on during narrow and wide holiday periods, respectively. Interventions: Narrow (7 weeks) and wide (14 weeks) Swedish holiday periods. Primary and secondary outcome measures: 90- day all-cause, 5-year all-cause and 5-year diseasespecific mortality. Results: Narrow holiday period did not increase allcause 90-day (HR=0.84, 95% CI 0.53 to 1.33), allcause 5-year (HR=1.01, 95% CI 0.85 to 1.21) or disease-specific 5-year mortality (HR=1.04, 95% CI 0.87 to 1.26). Similarly, wide holiday period did not increase the risk of 90-day (HR=0.79, 95% CI 0.55 to 1.13), all-cause 5-year (HR=0.96, 95% CI 0.84 to 1.1) or disease-specific 5-year mortality (HR=1.03, 95% CI 0.89 to 1.19). Conclusions: No measurable effects of holiday periods on short-term or longer term mortality following surgery for oesophageal cancer were observed in this population-based study, indicating that an adequate surgical experience was maintained during holiday periods.