Effects of night surgery on postoperative mortality and morbidity: a multicentre cohort study.
adverse events
anaesthesia
epidemiology and detection
standards of care
surgery
Journal
BMJ quality & safety
ISSN: 2044-5423
Titre abrégé: BMJ Qual Saf
Pays: England
ID NLM: 101546984
Informations de publication
Date de publication:
08 2021
08 2021
Historique:
received:
03
06
2020
revised:
04
09
2020
accepted:
09
09
2020
pubmed:
9
10
2020
medline:
28
10
2021
entrez:
8
10
2020
Statut:
ppublish
Résumé
Surgery at night (incision time 17:00 to 07:00 hours) may lead to increased postoperative mortality and morbidity. Mechanisms explaining this association remain unclear. We conducted a multicentre retrospective cohort study of adult patients undergoing non-cardiac surgery with general anaesthesia at two major, competing tertiary care hospital networks. In primary analysis, we imputed missing data and determined whether exposure to night surgery affects 30-day mortality using a mixed-effects model with individual anaesthesia and surgical providers as random effects. Secondary outcomes were 30-day morbidity and the mediating effect of blood transfusion rates and provider handovers on the effect of night surgery on outcomes. We further tested for effect modification by surgical setting. Among 350 235 participants in the primary imputed cohort, the mortality rate was 0.9% (n=2804/322 327) after day and 3.4% (n=940/27 908) after night surgery. Night surgery was associated with an increased risk of mortality (OR Night surgery was associated with an increased risk of postoperative mortality and morbidity. The effect was independent of case acuity and was mediated by potentially preventable factors: higher blood transfusion rates and more frequent provider handovers.
Sections du résumé
BACKGROUND
Surgery at night (incision time 17:00 to 07:00 hours) may lead to increased postoperative mortality and morbidity. Mechanisms explaining this association remain unclear.
METHODS
We conducted a multicentre retrospective cohort study of adult patients undergoing non-cardiac surgery with general anaesthesia at two major, competing tertiary care hospital networks. In primary analysis, we imputed missing data and determined whether exposure to night surgery affects 30-day mortality using a mixed-effects model with individual anaesthesia and surgical providers as random effects. Secondary outcomes were 30-day morbidity and the mediating effect of blood transfusion rates and provider handovers on the effect of night surgery on outcomes. We further tested for effect modification by surgical setting.
RESULTS
Among 350 235 participants in the primary imputed cohort, the mortality rate was 0.9% (n=2804/322 327) after day and 3.4% (n=940/27 908) after night surgery. Night surgery was associated with an increased risk of mortality (OR
CONCLUSIONS
Night surgery was associated with an increased risk of postoperative mortality and morbidity. The effect was independent of case acuity and was mediated by potentially preventable factors: higher blood transfusion rates and more frequent provider handovers.
Identifiants
pubmed: 33028658
pii: bmjqs-2020-011684
doi: 10.1136/bmjqs-2020-011684
doi:
Types de publication
Journal Article
Multicenter Study
Langues
eng
Pagination
678-688Informations de copyright
© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: ME has received unrestricted funds from philanthropic donors Jeffrey and Judith Buzen during the study period and has received grants for investigator-initiated trials not related to this manuscript from Merck & Co and serves as a consultant on the advisory board of Merck & Co. ME holds equity of Calabash Bioscience Inc. and is an Associate Editor of the British Journal of Anaesthesia.