Survival after radical cystectomy during holiday periods

Fredrik Liedberg,Oskar Hagberg,Firas Aljabery,Truls Gårdmark,Abolfazl Hosseini,Staffan Jahnson,Tomas Jerlström,Per-Uno Malmström,Amir Sherif,Karin Söderkvist,Viveka Ströck,Anders Ullén,Christel Häggström,Lars Holmberg

doi:10.1080/21681805.2021.1938665

Abstract

Objective For patients undergoing radical cystectomy for bladder cancer, a procedure requiring complex urinary tract reconstruction prone to major postoperative complications, the timing and quality of the surgery have been associated with outcomes. Patients and methods This study investigated if radical cystectomy for bladder cancer performed during holiday periods had worse disease-specific (DSS) and overall survival (OS), higher 90-day mortality and risk of readmissions. All patients operated on with radical cystectomy for primary bladder cancer during 1997–2014 with holiday periods as exposure (with one narrow (7 weeks) and one wider (14 weeks) definition) in the Swedish population-based bladder cancer research-database (BladderBaSe) were studied. DSS and OS after radical cystectomy during holiday periods were analysed with Cox regression models adjusted for sex, age, comorbidity, marital status, T-stage and nodal metastases, neoadjuvant chemotherapy, hospital volume and year of cystectomy. Results Surgery during the holiday periods (narrow and wide definitions) were not associated with DSS (Hazard ratio [HR] = 1.05, 95% confidence interval [95% CI] = 0.90–1.21 and HR = 1.04, 95% CI = 0.91–1.17), respectively. HRs for OS were similar, and no associations between radical cystectomy during any of the holiday period definitions and 90-day mortality and readmission were found. Conclusion Survival after radical cystectomy in Sweden is similar during holiday and non-holiday periods.

Highlights

Worse long-term all-cause and disease-specific survival have been associated with cancer surgeries performed during holiday periods for several cancer forms including kidney- and urinary bladder cancer [1]
The aim of the current study was to investigate survival after radical cystectomy for bladder cancer within holiday periods, as compared to outside holiday periods among all bladder cancer patients subjected to primary radical cystectomy in the Bladder cancer Database Sweden (BladderBaSe) from 1997 to 2014 [5]
To explore possible selection mechanisms by vacation period, we investigated monthly fluctuations in tumor stage at diagnosis and use of radical cystectomy and curative external beam irradiation, the number of patients diagnosed with tumor stage categories (Carcinoma in situ (Tis)/Ta/T1 vs T2 vs T3/T4), treated with radical cystectomy, and starting curative external beam irradiation were divided into months, and computed as quantity by number of days in the month

Summary

Introduction

Worse long-term all-cause and disease-specific survival have been associated with cancer surgeries performed during holiday periods for several cancer forms including kidney- and urinary bladder cancer [1]. In Sweden the holiday periods are mid-June to mid-August, and with a wider definition end of August and midDecember to mid-January, are associated with a reduction of elective healthcare and number of available hospital beds [4]. The aim of the current study was to investigate survival after radical cystectomy for bladder cancer within holiday periods, as compared to outside holiday periods among all bladder cancer patients subjected to primary radical cystectomy in the Bladder cancer Database Sweden (BladderBaSe) from 1997 to 2014 [5]. We investigated risk of postoperative mortality and hospital readmissions after radical cystectomy performed within as compared to outside holiday periods

Methods

Results

Conclusion