engleski

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

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

general anaesthesia ; intraoperative complications ; patient safety ; postoperative complications ; pulmonary

Croatia General Hospital Cakovec, Cakovec: Selma Pernar General Hospital Karlovac, Karlovac: Josip Zunic, Petar Miskovic, Antonio Zilic University Clinical Hospital Osijek, Osijek: Slavica Kvolik, Dubravka Ivic, Darija Azenic-Venzera, Sonja Skiljic, Hrvoje Vinkovic, Ivana Oputric University Hospital Rijeka, Rijeka: Kazimir Juricic, Vedran Frkovic General Hospital Dr J Bencevic, Slavonski Brod: Jasminka Kopic, Ivan Mirkovic University Hospital Center Split, Split: Nenad Karanovic, Mladen Carev, Natasa Dropulic University Hospital Merkur, Zagreb: Jadranka Pavicic Saric, Gorjana Erceg, Matea Bogdanovic Dvorscak University Hospital Sveti Duh, Zagreb: Branka Mazul- Sunko, Anna Marija Pavicic, Tanja Goranovic University Hospital, Medical school, “Sestre milosrdnice” (Sister of Charity), Zagreb: Branka Maldini, Tomislav Radocaj, Zeljka Gavranovic, Inga Mladic-Batinica, Mirna Sehovic