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Days of the week and 90-day mortality after esophagectomy: analysis of 33,980 patients from the National Clinical Database

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Abstract

Purpose

The effect of the days of the week on the short-term outcomes after elective surgeries has been suggested; however, such data on esophagectomies remain limited. This study aimed to investigate the association between the day of the week and mortality rates after elective esophagectomy using a large-scale clinical database in Japan.

Methods

The data of elective esophagectomies, registered in the National Clinical Database in Japan, for esophageal cancer treatment between 2012 and 2017 were analyzed. We hypothesized that the later days of the week could have higher odds ratios of death after elective esophagectomy. With 22 relevant clinical variables and days of surgery, 90-day mortality was evaluated using hierarchical logistic regression modeling.

Results

Ninety-day mortality rates among 33,980 patients undergoing elective esophagectomy were 1.8% (range, 1.5–2.1%). Surgeries were largely concentrated on earlier days of the week, whereas esophagectomies performed on Fridays accounted for only 11.1% of all cases. Before risk adjustment, lower odds ratios of 90-day mortality were found on Tuesday and a tendency towards lower odds ratios on Thursday. In the hierarchical logistic regression model, 21 independent factors of 90-day mortality were identified. However, the adjusted odds ratios of 90-day mortality for Tuesday, Wednesday, Thursday, and Friday were 0.87, 1.09, 0.85, and 0.88, respectively, revealing no significant difference.

Conclusion

The results imply that the variation in 90-day mortality rates after esophagectomy on different days of the week may be attributed to differing preoperative risk factors of the patient group rather than the disparity in medical care provided.

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Data and/or code availability

All available data was presented in the manuscript and Supplementary Information.

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Acknowledgements

We appreciate all participants for their contributions to data registration in the National Clinical Database. This study was evaluated and accepted by the Japanese Society of Hepato-Biliary-Pancreatic Surgery. This work was supported by the Japanese Society of Hepato-Biliary-Pancreatic Surgery in terms of funding and assistance in setting up and recording research meetings.

Funding

This study was supported by the Japanese Society of Hepato-Biliary-Pancreatic Surgery.

Author information

Authors and Affiliations

  1. Department of Surgery, Kochi Medical School, Oko-cho, Nankoku, Kochi, 783-8505, Japan

    Hiromichi Maeda, Sunao Uemura & Kazuhiro Hanazaki

  2. Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan

    Hideki Endo, Nao Ichihara & Hiroaki Miyata

  3. Project Management Subcommittee, The Japanese Society of Gastroenterological Surgery, Tokyo, Japan

    Hiroshi Hasegawa & Kinji Kamiya

  4. Database Committee, The Japanese Society of Gastroenterological Surgery, Tokyo, Japan

    Yoshihiro Kakeji

  5. Department of Gastroenterological and Pediatric Surgery, Graduate School of Medicine, Gifu University, Gifu, 501-1193, Japan

    Kazuhiro Yoshida

  6. Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan

    Yasuyuki Seto

  7. Second Department of Surgery, School of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama, 641-8510, Japan

    Hiroki Yamaue

  8. Utsunomiya Memorial Hospital, Utsunomiya, Tochigi, 320-0811, Japan

    Masakazu Yamamoto

  9. The Japanese Society of Gastroenterological Surgery, Tokyo, Japan

    Yuko Kitagawa

  10. Department of Surgery, Keio University School of Medicine, Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan

    Yuko Kitagawa

Authors
  1. Hiromichi Maeda
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Contributions

All authors contributed to the study conception and design: Dr Endo Hideki, Dr. Ichihara Nao, and Dr. Miyata Hiroaki had full access to all of the data in the study and took responsibility for the integrity of the data. Data analysis was performed by Dr. Endo Hideki and Dr. Ichihara Nao. All authors contributed to the interpretation. Dr. Maeda Hiromichi, Dr. Endo Hideki, Dr. Uemura Sunao, and Dr. Hanazaki Kazuhiro made significant contributions to manuscript drafting. All authors reviewed the manuscript. Dr. Kakeji Yoshihiro and Dr. Kitagawa Yuko performed critical revisions of the manuscript.

Corresponding author

Correspondence to Kazuhiro Hanazaki.

Ethics declarations

Ethics approval

This study’s protocol was accepted by the Japanese Society of Gastrointestinal Surgery and the Japanese Society of Hepato-Biliary-Pancreatic Surgery Committees. The study protocol was approved by the institutional review board of Kochi Medical School (ID: 31-67).

Consent to participate

The requirement for individual written informed consent was waived due to the retrospective design of this study.

Consent for publication

The requirement for individual written informed consent was waived due to the retrospective design of this study.

Competing interests

Dr. Hideki Endo, Dr. Nao Ichihara, and Dr. Hiroaki Miyata are affiliated with the Department of Healthcare Quality Assessment at the University of Tokyo, which is a social collaboration department supported by the National Clinical Database, Johnson & Johnson K.K., Nipro Corporation, and Intuitive Surgical Sàrl. Dr. Kitagawa reports grants and personal fees from ASAHI KASEI PHARMA CORPORATION, grants and personal fees from ONO PHARMACEUTICAL CO., LTD., grants, personal fees and other from TAIHO PHARMACEUTICAL CO., LTD, grants, personal fees and other from CHUGAI PHARMACEUTICAL CO., LTD., grants and personal fees from KAKEN PHARMACEUTICAL CO., LTD., grants and personal fees from EA Pharma Co., Ltd., grants and personal fees from Takeda Pharmaceutical Company Limited, grants and personal fees from TSUMURA & CO., personal fees from AstraZeneca K.K., personal fees from Ethicon Inc., personal fees from Olympus Corporation, personal fees from Cardinal Health K.K., personal fees from SHIONOGI & CO., LTD., personal fees from Bristol-Myers Squibb K.K., personal fees from MSD K.K., personal fees from Smith ＆ Nephew KK, personal fees from ASKA Pharmaceutical Co., Ltd., personal fees from MIYARISAN PHARMACEUTICAL CO. LTD., personal fees from Toray Industries, Inc., personal fees from DAIICHI SANKYO COMPANY, LIMITED, personal fees from Chugai Foundation for Innovative Drug Discovery Science, personal fees from Nippon Kayaku Co., Ltd., personal fees from Intuitive Surgical G.K., personal fees and other from SYSMEX CORPORATION, personal fees from AI Medical Service Inc., personal fees from Kowa Company, Ltd., personal fees from Eisai Co., Ltd., other from Medicaroid Corporation, outside the submitted work.

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Maeda, H., Endo, H., Ichihara, N. et al. Days of the week and 90-day mortality after esophagectomy: analysis of 33,980 patients from the National Clinical Database. Langenbecks Arch Surg 409, 36 (2024). https://doi.org/10.1007/s00423-023-03214-7

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