Adverse outcomes after planned surgery with anticipated intensive care admission in out-of-office-hours time periods: a multicentre cohort study

Abstract

Despite a greater clinical staff availability and higher monitoring levels, planned surgery requiring anticipated out-of-office-hours ICU admission was associated with a prolonged hospital LOS, reduced discharge directly home, and increased mortality compared with in-office-hours admissions. Our findings have potential clinical, economic and health policy implications on how complex planned surgery should be planned and managed.

Punctuality is the duty of subjects and the politeness of monarchs. Response to Br J Anaesth 2018; 121: 982–3

“…In the 141 420 patients included in this subgroup of out-of-office-hour admissions, both hospital length of stay and mortality remained worse than for those patients admitted during in-office-hours. 2 We also agree that the stratification of explicit cut-off times is arbitrary, and will neither be universally agreed to nor necessarily hospital specific. That said, we are comfortable with our line in the sand, and believe it is consistent with numerous other peer-reviewed publications and Anglo-Australian government documents cited in the methods section of our paper.…”

“…EditordWe thank Morton and Snow 1 for their interest in our recent manuscript 2 and for providing additional viewpoints into the issue of out-of-office-hours ICU admissions, a multifaceted topic pertinent to healthcare consumers, providers, and policymakers alike. We acknowledge that this topic remains controversial and that not all published data are consistent.…”

“…That said, we are comfortable with our line in the sand, and believe it is consistent with numerous other peer-reviewed publications and Anglo-Australian government documents cited in the methods section of our paper. 2 Importantly, a cut-off time does not merely reflect the productivity of the intensive care or theatre complex. When complications do occur during out-of-office-hour time periods, other supportive facilities have a reduced capacity (e.g.…”

Time waits for no intensivist. Comment on Br J Anaesth 2018; 120: 1420–8

“…EditordWe thank Morgan and colleagues 1 for their insightful cohort study; their approach of using the elective postoperative ICU admission population is novel and provides further insight into the effect of admission time on mortality. This topic has been highlighted by politicians and the media alike in recent times.…”

Best arrive on time

“…There was no difference in mortality comparing night time and day time weekday admissions. 2 In this issue of the British Journal of Anaesthesia, Morgan and colleagues 7 report the results of a retrospective analysis of the Australia and New Zealand ICU (ANZICS) database for all participating units in Australia and New Zealand. The database was interrogated to determine any possible effect of 'outof-office hours' ICU admission in those surgical patients who had a planned ICU admission.…”