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

A. Cortegiani (Corresponding Author), C. Gregoretti, A.S. Neto, S.N.T. Hemmes, L. Ball, J. Canet, M. Hiesmayr, M.W. Hollmann, G.H. Mills, M.F.V. Melo, C. Putensen, W. Schmid, P. Severgnini, H. Wrigge, M. Gama de Abreu, M.J. Schultz, P. Pelosi, W. Kroell, H. Metzler, G. StruberT. Wegscheider, H. Gombotz, B. Urbanek, D. Kahn, M. Momeni, A. Pospiech, F. Lois, P. Forget, I. Grosu, J. Poelaert, V. Mossevelde, M.C. van Malderen, D. Dylst, J.V. Melkebeek, M. Beran, S.D. Hert, L.D. Baerdemaeker, B. Heyse, J.V. Limmen, P. Wyffels, T. Jacobs, N. Roels, A.D. Bruyne, S.V.D. Velde, J.Z. Marina, D.O. Dejana, S. Pernar, J. Zunic, P. Miskovic, A. Zilic, S. Kvolik, D. Ivic, A.V. Darija, S. Skiljic, H. Vinkovic, I. Oputric, K. Juricic, V. Frkovic, J. Kopic, I. Mirkovic, J.P. Saric, G. Erceg, M.B. Dvorscak, M.S. Branka, A.M. Pavicic, T. Goranovic, B. Maldini, T. Radocaj, Z. Gavranovic, M.B. Inga, M. Sehovic, P. Stourac, H. Harazim, O. Smekalova, M. Kosinova, T. Kolacek, K. Hudacek, M. Drab, J. Brujevic, K. Vitkova, K. Jirmanova, I. Volfova, P. Dzurnakova, K. Liskova, R. Dudas, R. Filipsky, S.E. Kafrawy, H.H. Abdelwahab, T. Metwally, A.R. Ahmed, E.S. Ahmed Mostafa, W.F. Hasan, A.R. Ahmed, H. Yassin, M. Magdy, M. Abdelhady, M. Mahran, E. Herodes, P. Kivik, J. Oganjan, A. Aun, A. Sormus, K. Sarapuu, M. Mall, J. Karjagin, E. Futier, A. Petit, A. Gerard, E. Marret, M. Solier, S. Jaber, A. Prades, J. Krassler, S. Merzky, M.G.D. Abreu, C. Uhlig, T. Kiss, A. Bundy, T. Bluth, A. Gueldner, P. Spieth, M. Scharffenberg, D.T. Thiem, T. Koch, T. Treschan, M. Schaefer, B. Bastin, J. Geib, M. Weiss, P. Kienbaum, B. Pannen, A. Gottschalk, M. Konrad, D. Westerheide, B. Schwerdtfeger, P. Simon, A. Reske, C. Nestler, D. Valsamidis, K. Stroumpoulis, G. Antholopoulos, A. Andreou, D. Karapanos, K. Theodorak, G. Gkiokas, M.K. Tasoulis, T. Sidiropoulou, F. Zafeiropoulou, P. Florou, A. Pandazi, G. Tsaousi, C. Nouris, C. Pourzitaki, D. Bystritski, R. Pizov, A. Eden, C.V. Pesce, A. Campanile, A. Marrella, S. Grasso, M.D. Michele, F. Bona, G. Giacoletto, E. Sardo, L.G.V. Sottosanti, M. Solca, C.A. Volta, S. Spadaro, M. Verri, R. Ragazzi, R. Zoppellari, G. Cinnella, P. Raimondo, D.L. Bella, L. Mirabella, D. D'antini, A. Molin, I. Brunetti, A. Gratarola, G. Pellerano, R. Sileo, S. Pezzatto, L. Montagnani, L. Pasin, G. Landoni, A. Zangrillo, L. Beretta, A.L.D. Parma, V. Tarzia, R. Dossi, M.E. Sassone, D. Sances, S. Tredici, G. Spano, G. Castellani, L. Delunas, S. Peradze, M. Venturino, I. Arpino, S. Sher, C. Tommasino, F. Rapido, P. Morelli, M. Vargas, G. Servillo, S.M. Raineri, F. Montalto, V. Russotto, A. Giarratano, M. Baciarello, M. Generali, G. Cerati, Y. Leykin, F. Bressan, V. Bartolini, L. Zamidei, L. Brazzi, C. Liperi, G. Sales, L. Pistidda, E. Brugnoni, G. Musella, A. Bacuzzi, D. Muhardri, G.G. Agreta, F. Sada, A. Bytyqi, A. Karbonskiene, R. Aukstakalniene, Z. Teberaite, E. Salciute, R. Tikuisis, P. Miliauskas, S. Jurate, E. Kontrimaviciute, G. Tomkute, J. Xuereb, M. Bezzina, F.J. Borg, S. Hemmes, M. Schultz, M. Hollmann, I. Wiersma, J. Binnekade, L. Bos, C. Boer, A. Duvekot, B.I.‘. Veld, A. Werger, P. Dennesen, C. Severijns, J.D. Jong, J. Hering, R.V. Beek, S. Ivars, I.B. Jammer, A. Breidablik, K.S. Hodt, F. Fjellanger, M.V. Avalos, M.O. Jannicke, E. Andersson, S.K. Amir, R. Molina, S. Wutai, E. Morais, G. Tareco, D. Ferreira, J. Amaral, M.D.L.G. Castro, S. Cadilha, S. Appleton, S. Parente, M. Correia, D. Martins, A. Monteirosa, A. Ricardo, S. Rodrigues, L. Horhota, I.M. Grintescu, L. Mirea, I.C. Grintescu, D. Corneci, S. Negoita, M. Dutu, I. Popescu Garotescu, D. Filipescu, A.B. Prodan, G. Droc, R. Fota, M. Popescu, D. Tomescu, A.M. Petcu, M.I. Tudoroiu, A. Moise, C.T. Guran, I. Gherghina, D. Costea, I. Cindea, S.M. Copotoiu, R. Copotoiu, V. Barsan, Z. Tolcser, M. Riciu, S.G. Moldovan, M. Veres, A. Gritsan, T. Kapkan, G. Gritsan, O. Korolkov, A. Kulikov, A. Lubnin, A. Ovezov, P. Prokoshev, A. Lugovoy, N. Anipchenko, A. Babayants, I. Komissarova, K. Zalina, V. Likhvantsev, S. Fedorov, A. Lazukic, J. Pejakovic, D. Mihajlovic, Z. Kusnierikova, M. Zelinkova, K. Bruncakova, L. Polakovicova, V. Sobona, N.S. Barbka, P.G. Ana, M. Jovanov, B. Strazisar, M.B. Jasmina, N.J. Vesna, M. Voje, A. Grynyuk, I. Kostadinov, S.V. Alenka, V. Moral, M.C. Unzueta, C. Puigbo, J. Fava, E. Moret, M.R. Nunez, M. Sendra, A. Brunelli, F. Rodenas, P. Monedero, F.H. Martinez, M.J.Y. Temino, A.M. Simon, A.D.A. Larriba, A. Lisi, G. Perez, R. Martinez, M. Granell, J.T. Vivo, C.S. Ruiz, J.A.D. Andrés Ibañez, E. Pastor, M. Soro, C. Ferrando, M. Defez, A.S. Cesar Aldecoa, R. Perez, J. Rico, M. Jawad, Y. Saeed, L. Gillberg, Z.K. Bengisun, B.K. Kazbek, N. Coskunfirat, N. Boztug, S. Sanli, M. Yilmaz, N. Hadimioglu, N.M. Senturk, E. Camci, S. Kucukgoncu, Z. Sungur, N. Sivrikoz, S.U. Ozgen, F. Toraman, O. Selvi, O. Senturk, M. Yildiz, B. Kuvaki, F. Gunenc, S. Kucukguclu, S. Ozbilgin, J. Maral, S. Canli, O. Arun, A. Saltali, E. Aydogan, F.N. Akgun, C. Sanlikarip, F.M. Karaman, A. Mazur, S. Vorotyntsev, G. Rousseau, C. Barrett, L. Stancombe, B. Shelley, H. Scholes, J. Limb, A. Rafi, L. Wayman, J. Deane, D. Rogerson, J. Williams, S. Yates, E. Rogers, M. Pulletz, S. Moreton, S. Jones, S. Venkatesh, M. Burton, L. Brown, C. Goodall, M. Rucklidge, D. Fuller, M. Nadolski, S. Kusre, M. Lundberg, L. Everett, H. Nutt, M. Zuleika, P. Carvalho, D. Clements, C.B. Ben, P. Watt, P. Raymode, R. Pearse, O. Mohr, A. Raj, T. Creary, A. Chishti, A. Bell, C. Higham, A. Cain, S. Gibb, S. Mowat, D. Franklin, C. West, G. Minto, N. Boyd, G. Mills, E. Calton, R. Walker, F. Mackenzie, B. Ellison, H. Roberts, M. Chikungwa, C. Jackson, A. Donovan, J. Foot, E. Homan, J. Montgomery, D. Portch, P. Mercer, J. Palmer, J. Paddle, A. Fouracres, A. Datson, A. Andrew, L. Welch, A. Rose, S. Varma, K. Simeson, M. Rambhatla, J. Susarla, S. Marri, K. Kodaganallur, A. Das, S. Algarsamy, J. Colley, S. Davies, M. Szewczyk, T. Smith, F.B. Ana, E. Luzier, A. Almagro, M.V. Melo, L. Fernando, D. Sulemanji, J. Sprung, T. Weingarten, D. Kor, F. Scavonetto, Y. Tze

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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.
Original languageEnglish
Pages (from-to)361-369
Number of pages9
JournalBritish Journal of Anaesthesia
Volume122
Issue number3
Early online date8 Feb 2019
DOIs
Publication statusPublished - Mar 2019

Keywords

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

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    Cortegiani, A., Gregoretti, C., Neto, A. S., Hemmes, S. N. T., Ball, L., Canet, J., Hiesmayr, M., Hollmann, M. W., Mills, G. H., Melo, M. F. V., Putensen, C., Schmid, W., Severgnini, P., Wrigge, H., Gama de Abreu, M., Schultz, M. J., Pelosi, P., Kroell, W., Metzler, H., ... Tze, Y. (2019). Association between night-time surgery and occurrence of intraoperative adverse events and postoperative pulmonary complications. British Journal of Anaesthesia, 122(3), 361-369. https://doi.org/10.1016/j.bja.2018.10.063