TY - JOUR
T1 - Nonelective surgery at night and in-hospital mortality Prospective observational data from the European Surgical Outcomes Study
AU - van Zaane, Bas
AU - van Klei, Wilton A.
AU - Buhre, Wolfgang F.
AU - Bauer, Peter
AU - Boerma, E. Christiaan
AU - Hoeft, Andreas
AU - Metnitz, Philipp
AU - Moreno, Rui P.
AU - Pearse, Rupert
AU - Pelosi, Paolo
AU - Sander, Michael
AU - Vallet, Benoit
AU - Pettilä, Ville
AU - Vincent, Jean-Louis
AU - Rhodes, Andrew
AU - AUTHOR GROUP
AU - Moreno, Rui
AU - Spies, Claudia
AU - Hoste, Eric
AU - Huyghens, Luc
AU - Jacobs, Rita
AU - van Mossevelde, Veerle
AU - Opdenacker, Godelieve
AU - Poelaert, Jan
AU - Spapen, Herbert
AU - Leleu, Kris
AU - Rijckaert, Dirk
AU - de Decker, Koen
AU - Foubert, Luc
AU - de Neve, Nikolaas
AU - Biston, Patrick
AU - Piagnerelli, Michael
AU - Collin, Vincent
AU - den Blauwen, Nadia
AU - Clauwaert, Charlotte
AU - de Crop, Luc
AU - Verbeke, An
AU - Derumeaux, Pieter
AU - Gardin, Christophe
AU - Kindt, Sebastiaan
AU - Louage, Sofie
AU - Verhamme, Bruno
AU - Druwé, Patrick
AU - Lahaye, Ingrid
AU - Rosseel, Francis
AU - Rutsaert, Robert
AU - Vanlinthout, Luc
AU - de Kock, Marc
AU - Keijzer, Christaan
AU - Hollmann, Markus W.
AU - Preckel, Benedikt
PY - 2015
Y1 - 2015
N2 - 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
AB - 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
U2 - https://doi.org/10.1097/EJA.0000000000000256
DO - https://doi.org/10.1097/EJA.0000000000000256
M3 - Article
C2 - 26001104
SN - 0265-0215
VL - 32
SP - 477
EP - 485
JO - European Journal of Anaesthesiology
JF - European Journal of Anaesthesiology
IS - 7
ER -