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Association between night-time surgery and occurrence of intraoperative adverse events and postoperative pulmonary complications

(2019) BRITISH JOURNAL OF ANAESTHESIA. 122(3). p.361-369
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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.
Keywords
SLEEP-DEPRIVATION, MECHANICAL VENTILATION, INCREASED RISK, ANESTHESIA, OUTCOMES, PERFORMANCE, STRATEGIES, MORTALITY, TIME, general anaesthesia, intraoperative complications, patient safety, postoperative complications, pulmonary

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Chicago
Cortegiani, A., C. Gregoretti, A. S. Neto, S. N. T. Hemmes, L. Ball, J. Canet, M. Hiesmayr, et al. 2019. “Association Between Night-time Surgery and Occurrence of Intraoperative Adverse Events and Postoperative Pulmonary Complications.” British Journal of Anaesthesia 122 (3): 361–369.
APA
Cortegiani, A., Gregoretti, C., Neto, A. S., Hemmes, S. N. T., Ball, L., Canet, J., Hiesmayr, M., et al. (2019). Association between night-time surgery and occurrence of intraoperative adverse events and postoperative pulmonary complications. BRITISH JOURNAL OF ANAESTHESIA, 122(3), 361–369.
Vancouver
1.
Cortegiani A, Gregoretti C, Neto AS, Hemmes SNT, Ball L, Canet J, et al. Association between night-time surgery and occurrence of intraoperative adverse events and postoperative pulmonary complications. BRITISH JOURNAL OF ANAESTHESIA. Oxford: Elsevier Sci Ltd; 2019;122(3):361–9.
MLA
Cortegiani, A. et al. “Association Between Night-time Surgery and Occurrence of Intraoperative Adverse Events and Postoperative Pulmonary Complications.” BRITISH JOURNAL OF ANAESTHESIA 122.3 (2019): 361–369. Print.
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  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{\textlangle}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.},
  author       = {Cortegiani, A. and Gregoretti, C. and Neto, A. S. and Hemmes, S. N. T. and Ball, L. and Canet, J. and Hiesmayr, M. and Hollmann, M. W. and Mills, G. H. and Melo, M. F. V. and Putensen, C. and Schmid, W. and Severgnini, P. and Wrigge, H. and de Abreu, M. Gama and Schultz, M. 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  issn         = {0007-0912},
  journal      = {BRITISH JOURNAL OF ANAESTHESIA},
  language     = {eng},
  number       = {3},
  pages        = {361--369},
  publisher    = {Elsevier Sci Ltd},
  title        = {Association between night-time surgery and occurrence of intraoperative adverse events and postoperative pulmonary complications},
  url          = {http://dx.doi.org/10.1016/j.bja.2018.10.063},
  volume       = {122},
  year         = {2019},
}

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