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

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%; P¼0.029). PPCs also occurred more often in patients who underwent night-time surgery (14% vs 10%; P¼0.004) in an unmatched cohort analysis, although not in a propensity-matched analysis (13.8% vs 11.8%; P¼0.39). 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: 1.09e1.90; P¼0.01), but not with a higher incidence of PPCs (odds ratio: 1.32; 95% confidence interval: 0.89e1.90; P¼0.15). 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.

Impact of Regional Block Failure in Ambulatory Hand Surgery on Patient Management: A Cohort Study

“…Beyond the statistical question, this means the number of patients that need to be treated (i.e., switched from a conventional to an ambulatory surgical unit) to avoid one additional failure would be 2.9 (95% CI: 1.4, 7.5). We suggest that operating on ambulatory patients outside of regular hours may increase the postoperative morbidity, as already described for other procedures [15,16].…”

Perioperative anaesthetic management of patients with or at risk of acute distress respiratory syndrome undergoing emergency surgery

“…[10,22,28]. In a large cohort of surgical patients, emergency procedures performed during night-time were independently associated with higher incidence of intraoperative adverse events and PPCs [29]: this might suggest that delaying interventions when feasible might improve surgical outcomes.…”

Perioperative anaesthetic management of patients with or at risk of acute distress respiratory syndrome undergoing emergency surgery

“…Several surgical procedures and techniques are at higher risk, such as open versus laparoscopic, upper abdominal incision, longer procedures and those requiring general anaesthesia and neuromuscular blockade [10,22,28]. In a large cohort of surgical patients, emergency procedures performed during night-time were independently associated with higher incidence of intraoperative adverse events and PPCs [29]: this might suggest that delaying interventions when feasible might improve surgical outcomes.…”