Survival after radical cystectomy during holiday periods

Figures & data

Table 1. Distribution of descriptive data in all patients and within holiday periods using a narrow definition (25 June to 15 August) and a wider holiday definition (16 June to 31 August and 16 December to 7 January).

	Study population (%)	Patients operated outside narrow holiday period (%)	Patients operated within narrow holiday period (%)	Patients operated outside wide holiday period (%)	Patients operated within wide holiday period (%)
Sex
Male	2,969 (75)	2,624 (76)	345 (73)	2,327 (75)	642 (75)
Female	974 (25)	847 (24)	127 (27)	758 (25)	216 (25)
Age
<65	1,292 (33)	1,150 (33)	142 (30)	1,016 (33)	276 (32)
65+	2,651 (67)	2,321 (67)	330 (70)	2,069 (67)	582 (68)
CCI
CCI = 0	2,812 (71)	2,471 (71)	341 (72)	2,198 (71)	614 (72)
CCI > 0	1,131 (29)	1,000 (29)	131 (28)	887 (29)	244(28)
Marital status
Not married, divorced or widowed	1,470 (37)	1,285 (37)	185 (39)	1,148 (37)	322 (38)
Married	2,473 (63)	2,186 (63)	287 (61)	1,937 (63)	536 (63)
T stage category
Tis/Ta/T1	699 (18)	626 (18)	73 (16)	544 (18)	155 (18)
T2	2,340 (59)	2,065 (60)	275 (58)	1,830 (59)	510 (59)
T3/T4	904 (23)	780 (23)	124 (26)	711 (23)	193 (23)
Nodal metastases
No	3,535 (90)	3,120 (90)	415 (88)	2,766 (90)	769 (90)
Yes	408 (10)	351 (10)	57 (12)	319 (10)	89 (10)
Neoadjuvant treatment
No	3,487 (88)	3,078 (89)	415 (87)	2,742 (89)	745 (87)
Yes	456 (12)	393 (11)	63 (13)	343 (11)	113 (13)
Period-specific mean annual volume (PSMAV)
0–10	1,201 (31)	1,060 (31)	141 (30)	939 (30)	262 (31)
10–25	1,546 (39)	1,360 (39)	186 (39)	1,214 (39)	332 (39)
25–75	1,196 (30)	1,051 (30)	145 (31)	932 (30)	264 (31)
Year of cystectomy
1997–2005	1,514 (38)	1,322 (38)	192 (41)	1,183 (38)	331 (39)
2006–2014	2,429 (62)	2,149 (62)	280 (59)	1,902 (62)	527 (61)

The proportion of patients operated on in low (0–10), median (10–25) and high-volume hospitals (25–75) are given based on the period-specific mean annual volume (PSMAV) during the 3 preceding years. CCI, Charlson Comorbidity Index.

Table 2. Distribution of stage groups per month (p = 0.2), total number of patients in relation to starting date for patients subjected to curative external beam irradiation for bladder cancer per month in the study, and mean number of patients per day for each month (p = 0.04), and total number of patients subjected to radical cystectomy per month in the study, and mean number of radical cystectomies per day for each month (p = 0.02) (p-values from Chi-square tests).

Month	Non-muscle invasive disease	cT2	cT3/T4	Total number of patients subjects to curative external beam radiation	Mean numbers/day	Total number of patients subjected to radical cystectomy	Mean numbers/day
January	55 (17%)	198 (60%)	75 (23%)	44	1.4	346	11.2
February	49 (16%)	185 (62%)	66 (22%)	23	0.8	312	11.0
March	78 (20%)	216 (57%)	88 (23%)	24	0.8	397	12.8
April	42 (13%)	193 (61%)	82 (26%)	36	1.2	336	11.2
May	82 (22%)	203 (55%)	81 (22%)	38	1.2	386	12.5
June	41 (13%)	213 (66%)	67 (21%)	41	1.4	334	11.1
July	63 (20%)	176 (56%)	74 (24%)	31	1.0	325	10.5
August	55 (18%)	168 (56%)	78 (26%)	46	1.5	314	10.1
September	54 (17%)	194 (60%)	75 (23%)	49	1.6	335	11.2
October	64 (18%)	205 (59%)	78 (22%)	46	1.5	357	11.5
November	53 (17%)	189 (62%)	63 (21%)	38	1.3	325	10.8
December	63 (19%)	200 (59%)	77 (23%)	37	1.2	351	11.3

Table 3. Multivariate Cox regression (disease specific survival (DSS) and overall survival (OS)) for patients operated on within narrow (25 June to 15 August) and wide (16 June to 31 August and 16 December to 7 January) holiday periods compared to patients operated on outside the respective holiday period.

	Numbers of patients	HR (DSS)	95% CI	HR (OS)	95% CI
Radical cystectomy in relation to narrow holiday period
Outside	3,471	1, ref		1, ref
Within	472	1.05	0.90–1.21	1.00	0.88–1.14
Radical cystectomy in relation to wide holiday period
Outside	3,085	1, ref		1, ref
Within	858	1.04	0.91–1.17	0.98	0.88–1.09

Abbreviations: CCI, Charlson Comorbidity Index; CI, Confidence Interval; CIS, Carcinoma In Situ; DSS, Disease-Specific Survival; HR, Hazard Ratio; IQR, Inter Quartile Range; OS, Overall Survival; PSMAV, Period-Specific Mean Annual Volume.

HRs are adjusted for sex, age (stratified above and below 65 years of age), comorbidity (Charlson comorbidity index 0 or above), marital status, T-stage group stratified in non-muscle invasive disease (Tis/Ta/T1, stage T2, and stage T3/T4), nodal metastases, neoadjuvant chemotherapy, hospital volume of radical cystectomy (low [0–10], median [10–25], and high volume hospitals [25–75] based on the period-specific mean annual volume (PSMAV)), and year of cystectomy (1997–2005 vs 2006–2014). HR, Hazard Ratio; CI, Confidence interval; DSS, Disease-specific survival; OS, Overall survival.