Impact of holiday periods on glioblastoma surgery: a Dutch nationwide population-based cohort study

Ensuring high-quality surgical care is challenging during holiday periods due to potential reduction of capacity as well as availability of specialised personnel. Recently, quality of care for patients with gastric cancer in the Netherlands was found to be lower during the holiday periods. The effect of the holiday periods on quality of care on brain cancer, specifically glioblastoma surgery in the Netherlands, has not been investigated. Therefore, this study aimed to examine whether surgery during holiday periods is associated with differences in survival, early mortality, extent of resection (EOR), complications, weekly number of operations and time from diagnosis to treatment. This nationwide retrospective cohort study utilised data from the Dutch Brain Tumour Registry (DBTR) to analyse 4053 glioblastoma patients undergoing first-time resective surgery between 2014 and 2021. Three holiday periods were studied to reflect different levels of healthcare disruption: broad, narrow and summer. We compared holiday and non-holiday periods in terms of survival, early mortality (< 30 days), residual tumour presence after surgery, complications (Clavien-Dindo classification ≥ 3), performance decline (Karnofsky performance decline ≥ 10 at six weeks after surgery), weekly number of operations and time from diagnosis to treatment (> 21 days). Analyses were performed using chi-squared statistics, Kaplan-meier curves, Cox-regression, Poisson and logistic regression models. Surgery during holiday periods was not associated with differences in survival (adjusted hazard ratio 1.048, 95% confidence interval (CI) 0.949–1.158; p = 0.350), early mortality (adjusted odds ratio (aOR) 1.087, 95% CI 0.608–1.939; p = 0.779), complications (aOR 1.118, 95% CI 0.794–1.574; p = 0.524), residual tumour presence (aOR = 0.779, 95% CI 0.603–1.059; p = 0.119), performance decline (aOR 0.858, 95% CI 0.719–1.023; p = 0.088) or time from diagnosis to treatment > 21 days (aOR 0.868, 95% CI 0.710–1.062; p = 0.169). There was a significantly lower number of weekly operations in the holiday group compared to the non-holiday group (incidence rate ratio 0.920, 95% CI 0.858–0.986; p = 0.018). These findings suggest that while there is a significant decrease in the number of surgeries, outcomes of glioblastoma surgery were not indicated to differ.