Outcomes After Colorectal Cancer Surgery on Weekends May be Linked to Staffing Issues

A recent Dutch study of patients with colon and rectal cancer who underwent surgery suggests that outcomes from emergency weekend surgeries may be worse compared with those who had surgery on weekdays.¹

Approximately 5000 non-elective surgery patients’ outcomes were audited from a 3-year period, using 3 outcome measures: death within 30 days of the surgery, severe complications leading to a more than 2-week hospital stay, or complications leading to death within 30 days of the surgery (failure to rescue). The aim of the study was to see if there was a difference between outcomes in weekend versus weekday emergency surgery. The “weekend effect” is well-documented in medical research.²

In emergency situations, weekend surgeries resulted in 66% higher mortality rates and 29% higher severe complication rates than weekday surgeries.

The number of rectal cancer surgeries studied were smaller and while the estimates were similar, they were not statistically significant.

The researchers suggested that weekend surgeries may be affected by factors such as:

• the patient being in worse condition when presenting to the hospital on a weekend
• staffing mixes and skill levels of hospital staff on weekends might consist of less experienced surgeons and staff in the surgical setting as well as in post-op care
• being able to identify complications at an earlier stage

Limitations of the study included lack of data following patients beyond 30 days post-operatively, and a lack of information about the day of admission circumstances of surgical patients; for example, if less emergent surgeries were postponed until Monday.

Takeaways for Oncology Nurses

Oncology nurses must be sure we always have the adequate staffing mix of skill and experience, including weekends, to anticipate and account for adjustments in acuity that can result from emergent situations. Being an advocate for patients means that we must insist on having enough staff to ensure safety and good outcomes throughout the patient’s care, from admission through surgery through the post-operative period.

Being vocal and vigilant is our duty to the patient and our own professionalism as nurses. We cannot shrink into the corner and be intimidated by the prospect of raising our voices when it is in our patients’ best interests. We must be willing to stand up for our patients as well as each other when administrative decisions compromise our ability to uphold our duty to the patient.

References

• Huijit, DD, van Groningen, JT, Guicherit OR, et al. Weekend effect in emergency colon and rectal cancer surgery: A prospective study using data from the Dutch Colorectal Audit. J Natl Compr Canc Netw. 2018;16(6):735-741. doi: 10.6004/jnccn.2018.7016.
• Pauls LA, Johnson-Paben R, McGready J, Murphy JD, Pronovost PJ, Wu CL. The weekend effect in hospitalized patients: A meta-analysis. J Hosp Med. 2017;12(9):760-766. doi:10.12788/jhm.2815.