A Cortegiani1, C Gregoretti2, A S Neto3, S N T Hemmes4, L Ball5, J Canet6, M Hiesmayr7, M W Hollmann8, G H Mills9, M F V Melo10, C Putensen11, W Schmid7, P Severgnini12, H Wrigge13, M Gama de Abreu14, M J Schultz15, P Pelosi5. 1. Department of Surgical, Oncological and Oral Science, Section of Anesthesia, Analgesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, University of Palermo, Palermo, Italy. Electronic address: andrea.cortegiani@unipa.it. 2. Department of Surgical, Oncological and Oral Science, Section of Anesthesia, Analgesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, University of Palermo, Palermo, Italy. 3. Department of Intensive Care and Laboratory of Experimental Intensive Care and Anesthesia, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil. 4. Department of Intensive Care and Laboratory of Experimental Intensive Care and Anesthesia, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Department of Anaesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands. 5. Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate, Università degli Studi di Genova, Genova, Italy; IRCCS Ospedale Policlinico San Martino, Genova, Italy. 6. Department of Anesthesiology and Postoperative Care, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain. 7. Division of Cardiac, Thoracic, Vascular Anesthesia and Intensive Care, Medical University of Vienna, Vienna, Austria. 8. Department of Anaesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands. 9. Operating Services, Critical Care and Anesthesia, Sheffield Teaching Hospitals, Sheffield and University of Sheffield, Sheffield, UK. 10. Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA. 11. Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany. 12. Department of Biotechnology and Sciences of Life, ASST Sette Laghi Ospedale di Circolo e Fondazione Macchi, University of Insubria, Varese, Italy. 13. Department of Anesthesiology and Intensive Care Medicine, University of Leipzig, Leipzig, Germany. 14. Department of Anaesthesiology and Intensive Care Medicine, Pulmonary Engineering Group, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany. 15. Department of Intensive Care and Laboratory of Experimental Intensive Care and Anesthesia, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Mahidol Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand.
Abstract
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.
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.
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