Nonelective surgery at night and in-hospital mortality

Autor: Maria Wittmann, Donaldo S Arteta-Arteta, Maurizio Cecconi, E. Christiaan Boerma, Anne Godier, Miriam De Nadal, Jordi Rello, Rupert Pearse, Tina Tomić Mahečić, Ari Ercole, Pablo Monedero, Manu Malbrain, Theodoros Kyprianou, De Rudnicki Stephane, Paolo Pelosi, Andrew Rhodes, Andrej Šribar, Isabel Gracia, Oana Roxana Ciobotaru, Joana Berger-Estilita, Stefano Turi, Anders Oldner, Jadranka Pavičić Šarić, Francesco Forfori, Tamas Szakmany, JESUS CABALLERO, Dhruv Parekh, Beatriz Tena, Banwari Agarwal, Anca Irina Ristescu, RODRIGO POVES ALVAREZ, Morten Bestle, Salvatore Grasso, Monir Jawad, Jose Trenado Álvarez, Helena Barrasa, Artigas Antonio, Marcela Vizcaychipi, Michael Grocott, Ioana Grigoras, Carlos Serón, Jean-Louis Vincent
Přispěvatelé: Anesthesiologie, MUMC+: MA Anesthesiologie (9), RS: MHeNs - R3 - Neuroscience, Translational Physiology, Anesthesiology, ACS - Amsterdam Cardiovascular Sciences, AII - Amsterdam institute for Infection and Immunity, Supporting clinical sciences, Research Group Critical Care and Cerebral Resuscitation, Intensive Care, Heller, Axel R.
Rok vydání: 2015
Předmět:
Adult
Male
Emergency Medical Services
Night Care
medicine.medical_specialty
nonelective surgery
night
in-hospital mortality
Evening
Adolescent
anaesthesia
surgery
outcome
lnfectious Diseases and Global Health Radboud Institute for Molecular Life Sciences [Radboudumc 4]
Comorbidity
Cohort Studies
Young Adult
03 medical and health sciences
0302 clinical medicine
030202 anesthesiology
medicine
Humans
outcomes
hospital mortality
ddc:610
Hospital Mortality
Prospective Studies
030212 general & internal medicine
Prospective cohort study
Aged
Medicine(all)
Aged
80 and over
Surgeons
business.industry
Research Support
Non-U.S. Gov't
Odds ratio
Middle Aged
Confidence interval
3. Good health
Surgery
Transplantation
Treatment Outcome
Anesthesiology and Pain Medicine
Sample Size
Surgical Procedures
Operative
Cohort
observational study
Female
business
Operative surgical procedures mortality adverse effects
Postoperative complications
Epidemiological Study
Cohort study
Zdroj: European Journal of Anaesthesiology, 32, 7, pp. 477-85
European Journal of Anaesthesiology, 32(7), 477-485. LIPPINCOTT WILLIAMS & WILKINS
European Journal of Anaesthesiology, 32, 477-85
European journal of anaesthesiology, 32(7), 477-485. Wolters Kluwer Health
ISSN: 0265-0215
DOI: 10.1097/eja.0000000000000256
Popis: BACKGROUND: Evidence suggests that sleep deprivation associated with night-time working may adversely affect performance resulting in a reduction in the safety of surgery and anaesthesia. OBJECTIVE: Our primary objective was to evaluate an association between nonelective night-time surgery and in-hospital mortality. We hypothesised that urgent surgery performed during the night was associated with higher in-hospital mortality and also an increase in the duration of hospital stay and the number of admissions to critical care. DESIGN: A prospective cohort study. This is a secondary analysis of a large database related to perioperative care and outcome (European Surgical Outcome Study). SETTING: Four hundred and ninety-eight hospitals in 28 European countries. PATIENTS: Men and women older than 16 years who underwent nonelective, noncardiac surgery were included according to time of the procedure. INTERVENTION: None. MAIN OUTCOME MEASURES: Primary outcome was in-hospital mortality; the secondary outcome was the duration of hospital stay and critical care admission. RESULTS: Eleven thousand two hundred and ninety patients undergoing urgent surgery were included in the analysis with 636 in-hospital deaths (5.6%). Crude mortality odds ratios (ORs) increased sequentially from daytime [426 deaths (5.3%)] to evening [150 deaths (6.0%), OR 1.14; 95% confidence interval 0.94 to 1.38] to night-time [60 deaths (8.3%), OR 1.62; 95% confidence interval 1.22 to 2.14]. Following adjustment for confounding factors, surgery during the evening (OR 1.09; 95% confidence interval 0.91 to 1.31) and night (OR 1.20; 95% confidence interval 0.9 to 1.6) was not associated with an increased risk of postoperative death. Admittance rate to an ICU increased sequentially from daytime [891 (11.1%)], to evening [347 (13.8%)] to night time [149 (20.6%)]. CONCLUSION: In patients undergoing nonelective urgent noncardiac surgery, in-hospital mortality was associated with well known risk factors related to patients and surgery, but we did not identify any relationship with the time of day at which the procedure was performed.
BACKGROUND: Evidence suggests that sleep deprivation associated with night-time working may adversely affect performance resulting in a reduction in the safety of surgery and anaesthesia. OBJECTIVE: Our primary objective was to evaluate an association between nonelective night-time surgery and in-hospital mortality. We hypothesised that urgent surgery performed during the night was associated with higher in-hospital mortality and also an increase in the duration of hospital stay and the number of admissions to critical care. DESIGN: A prospective cohort study. This is a secondary analysis of a large database related to perioperative care and outcome (European Surgical Outcome Study). SETTING: Four hundred and ninety-eight hospitals in 28 European countries. PATIENTS: Men and women older than 16 years who underwent nonelective, noncardiac surgery were included according to time of the procedure. INTERVENTION: None. MAIN OUTCOME MEASURES: Primary outcome was in-hospital mortality; the secondary outcome was the duration of hospital stay and critical care admission. RESULTS: Eleven thousand two hundred and ninety patients undergoing urgent surgery were included in the analysis with 636 in-hospital deaths (5.6%). Crude mortality odds ratios (ORs) increased sequentially from daytime [426 deaths (5.3%)] to evening [150 deaths (6.0%), OR 1.14; 95% confidence interval 0.94 to 1.38] to night-time [60 deaths (8.3%), OR 1.62; 95% confidence interval 1.22 to 2.14]. Following adjustment for confounding factors, surgery during the evening (OR 1.09; 95% confidence interval 0.91 to 1.31) and night (OR 1.20; 95% confidence interval 0.9 to 1.6) was not associated with an increased risk of postoperative death. Admittance rate to an ICU increased sequentially from daytime [891 (11.1%)], to evening [347 (13.8%)] to night time [149 (20.6%)]. CONCLUSION: In patients undergoing nonelective urgent noncardiac surgery, in-hospital mortality was associated with well known risk factors related to patients and surgery, but we did not identify any relationship with the time of day at which the procedure was performed. TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT01203605.
Databáze: OpenAIRE
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