Association between night-time surgery and occurrence of intraoperative adverse events and postoperative pulmonary complications.
Adult
After-Hours Care
/ statistics & numerical data
Aged
Cohort Studies
Female
Humans
Incidence
Internationality
Intraoperative Complications
/ epidemiology
Lung Diseases
/ epidemiology
Male
Middle Aged
Postoperative Complications
/ epidemiology
Prospective Studies
Risk Factors
Surgical Procedures, Operative
general anaesthesia
intraoperative complications
patient safety
postoperative complications
pulmonary
Journal
British journal of anaesthesia
ISSN: 1471-6771
Titre abrégé: Br J Anaesth
Pays: England
ID NLM: 0372541
Informations de publication
Date de publication:
Mar 2019
Mar 2019
Historique:
received:
09
08
2018
revised:
21
10
2018
accepted:
28
10
2018
entrez:
17
2
2019
pubmed:
17
2
2019
medline:
23
4
2019
Statut:
ppublish
Résumé
The aim of this post hoc analysis of a large cohort study was to evaluate the association between night-time surgery and the occurrence of intraoperative adverse events (AEs) and postoperative pulmonary complications (PPCs). LAS VEGAS (Local Assessment of Ventilatory Management During General Anesthesia for Surgery) was a prospective international 1-week study that enrolled adult patients undergoing surgical procedures with general anaesthesia and mechanical ventilation in 146 hospitals across 29 countries. Surgeries were defined as occurring during 'daytime' when induction of anaesthesia was between 8:00 AM and 7:59 PM, and as 'night-time' when induction was between 8:00 PM and 7:59 AM. Of 9861 included patients, 555 (5.6%) underwent surgery during night-time. The proportion of patients who developed intraoperative AEs was higher during night-time surgery in unmatched (43.6% vs 34.1%; P<0.001) and propensity-matched analyses (43.7% vs 36.8%; P=0.029). PPCs also occurred more often in patients who underwent night-time surgery (14% vs 10%; P=0.004) in an unmatched cohort analysis, although not in a propensity-matched analysis (13.8% vs 11.8%; P=0.39). In a multivariable regression model, including patient characteristics and types of surgery and anaesthesia, night-time surgery was independently associated with a higher incidence of intraoperative AEs (odds ratio: 1.44; 95% confidence interval: 1.09-1.90; P=0.01), but not with a higher incidence of PPCs (odds ratio: 1.32; 95% confidence interval: 0.89-1.90; P=0.15). Intraoperative adverse events and postoperative pulmonary complications occurred more often in patients undergoing night-time surgery. Imbalances in patients' clinical characteristics, types of surgery, and intraoperative management at night-time partially explained the higher incidence of postoperative pulmonary complications, but not the higher incidence of adverse events. NCT01601223.
Sections du résumé
BACKGROUND
The aim of this post hoc analysis of a large cohort study was to evaluate the association between night-time surgery and the occurrence of intraoperative adverse events (AEs) and postoperative pulmonary complications (PPCs).
METHODS
LAS VEGAS (Local Assessment of Ventilatory Management During General Anesthesia for Surgery) was a prospective international 1-week study that enrolled adult patients undergoing surgical procedures with general anaesthesia and mechanical ventilation in 146 hospitals across 29 countries. Surgeries were defined as occurring during 'daytime' when induction of anaesthesia was between 8:00 AM and 7:59 PM, and as 'night-time' when induction was between 8:00 PM and 7:59 AM.
RESULTS
Of 9861 included patients, 555 (5.6%) underwent surgery during night-time. The proportion of patients who developed intraoperative AEs was higher during night-time surgery in unmatched (43.6% vs 34.1%; P<0.001) and propensity-matched analyses (43.7% vs 36.8%; P=0.029). PPCs also occurred more often in patients who underwent night-time surgery (14% vs 10%; P=0.004) in an unmatched cohort analysis, although not in a propensity-matched analysis (13.8% vs 11.8%; P=0.39). In a multivariable regression model, including patient characteristics and types of surgery and anaesthesia, night-time surgery was independently associated with a higher incidence of intraoperative AEs (odds ratio: 1.44; 95% confidence interval: 1.09-1.90; P=0.01), but not with a higher incidence of PPCs (odds ratio: 1.32; 95% confidence interval: 0.89-1.90; P=0.15).
CONCLUSIONS
Intraoperative adverse events and postoperative pulmonary complications occurred more often in patients undergoing night-time surgery. Imbalances in patients' clinical characteristics, types of surgery, and intraoperative management at night-time partially explained the higher incidence of postoperative pulmonary complications, but not the higher incidence of adverse events.
CLINICAL TRIAL REGISTRATION
NCT01601223.
Identifiants
pubmed: 30770054
pii: S0007-0912(18)31333-3
doi: 10.1016/j.bja.2018.10.063
pii:
doi:
Banques de données
ClinicalTrials.gov
['NCT01601223']
Types de publication
Journal Article
Multicenter Study
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
361-369Investigateurs
W Kroell
(W)
H Metzler
(H)
G Struber
(G)
T Wegscheider
(T)
H Gombotz
(H)
M Hiesmayr
(M)
W Schmid
(W)
B Urbanek
(B)
D Kahn
(D)
M Momeni
(M)
A Pospiech
(A)
F Lois
(F)
P Forget
(P)
I Grosu
(I)
J Poelaert
(J)
V Mossevelde
(V)
M C van Malderen
(MC)
D Dylst
(D)
J V Melkebeek
(JV)
M Beran
(M)
S D Hert
(SD)
L D Baerdemaeker
(LD)
B Heyse
(B)
J V Limmen
(JV)
P Wyffels
(P)
T Jacobs
(T)
N Roels
(N)
A D Bruyne
(AD)
S V D Velde
(SVD)
J Z Marina
(JZ)
D O Dejana
(DO)
S Pernar
(S)
J Zunic
(J)
P Miskovic
(P)
A Zilic
(A)
S Kvolik
(S)
D Ivic
(D)
A V Darija
(AV)
S Skiljic
(S)
H Vinkovic
(H)
I Oputric
(I)
K Juricic
(K)
V Frkovic
(V)
J Kopic
(J)
I Mirkovic
(I)
J P Saric
(JP)
G Erceg
(G)
M B Dvorscak
(MB)
M S Branka
(MS)
A M Pavicic
(AM)
T Goranovic
(T)
B Maldini
(B)
T Radocaj
(T)
Z Gavranovic
(Z)
M B Inga
(MB)
M Sehovic
(M)
P Stourac
(P)
H Harazim
(H)
O Smekalova
(O)
M Kosinova
(M)
T Kolacek
(T)
K Hudacek
(K)
M Drab
(M)
J Brujevic
(J)
K Vitkova
(K)
K Jirmanova
(K)
I Volfova
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P Dzurnakova
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K Liskova
(K)
R Dudas
(R)
R Filipsky
(R)
S E Kafrawy
(SE)
H H Abdelwahab
(HH)
T Metwally
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A R Ahmed
(AR)
E S Ahmed Mostafa
(ES)
W F Hasan
(WF)
A G Ahmed
(AG)
H Yassin
(H)
M Magdy
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M Abdelhady
(M)
M Mahran
(M)
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A Aun
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A Sormus
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K Sarapuu
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M Mall
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J Karjagin
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E Futier
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A Petit
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A Gerard
(A)
E Marret
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M Solier
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J Krassler
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S Merzky
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(MGD)
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T Kiss
(T)
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A Gueldner
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P Spieth
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(DT)
T Koch
(T)
T Treschan
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M Schaefer
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B Bastin
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M Weiss
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G Antholopoulos
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A Duvekot
(A)
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(BI')
A Werger
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C Severijns
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J D Jong
(JD)
J Hering
(J)
R V Beek
(RV)
S Ivars
(S)
I B Jammer
(IB)
A Breidablik
(A)
K S Hodt
(KS)
F Fjellanger
(F)
M V Avalos
(MV)
M O Jannicke
(MO)
E Andersson
(E)
S K Amir
(SK)
R Molina
(R)
S Wutai
(S)
E Morais
(E)
G Tareco
(G)
D Ferreira
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J Amaral
(J)
M D L G Castro
(MDLG)
S Cadilha
(S)
S Appleton
(S)
S Parente
(S)
M Correia
(M)
D Martins
(D)
A Monteirosa
(A)
A Ricardo
(A)
S Rodrigues
(S)
L Horhota
(L)
I M Grintescu
(IM)
L Mirea
(L)
I C Grintescu
(IC)
D Corneci
(D)
S Negoita
(S)
M Dutu
(M)
I Popescu Garotescu
(I)
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A B Prodan
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G Droc
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A M Petcu
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M I Tudoroiu
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A Moise
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C T Guran
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I Gherghina
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O Korolkov
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A Kulikov
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V Moral
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C Puigbo
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M Sendra
(M)
A Brunelli
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A Martinez-Simon
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A Abajo
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A Lisi
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G Perez
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R Martinez
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M Granell
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C Ferrando
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M Defez
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R Perez
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J Rico
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L Gillberg
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B K Kazbek
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S Sanli
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M Yilmaz
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N Hadimioglu
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N M Senturk
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E Camci
(E)
S Kucukgoncu
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Z Sungur
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N Sivrikoz
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S U Ozgen
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F Toraman
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O Selvi
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O Senturk
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M Yildiz
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F Gunenc
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A Saltali
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E Aydogan
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C Sanlikarip
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F M Karaman
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G Rousseau
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A Almagro
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(Y)
Informations de copyright
Copyright © 2018 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.