Impact of daily, weekly, and seasonal surgical timing on postoperative outcomes in high-risk patients undergoing elective non-cardiac surgery: A retrospective, single-center study
Ji-Hoon Sim PhD , Yong-Seok Park PhD , Bumwoo Park PhD , Yeseul Choi MSc , Joon Seo Lim PhD , Seungil Ha PhD , Joung Uk Kim PhD
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引用次数: 0
Abstract
Background
Limited knowledge exists on the impact of surgical start timing on outcomes in high-risk patients. This study assessed its association with mortality, morbidity, and healthcare resource utilization in elective non-cardiac surgery.
Methods
A retrospective cohort study was conducted at a tertiary medical center, including 14,394 high-risk patients (ASA ≥ 3) undergoing elective non-cardiac surgery from 2012 to 2021. Patients were grouped by surgical start time into detailed time intervals (8:00–11:00 a.m., 11:00 a.m.–1:00 p.m., 1:00–3:00 p.m., 3:00–6:00 p.m.) and broader periods (morning vs. afternoon). Weekly (Monday–Wednesday vs. Thursday–Friday) and seasonal (spring, summer, fall, winter) variations were analyzed. Cox and logistic regression models assessed mortality, complications, and healthcare utilization.
Results
Afternoon surgeries were associated with higher mortality at 90 days (adjusted hazard ratio [aHR]: 1.28, 95 % confidence interval [CI]: 1.05–1.57, P = 0.016), 180 days (aHR: 1.30, 95 % CI: 1.12–1.51, P < 0.001), and 1 year (aHR: 1.26, 95 % CI: 1.13–1.40, P < 0.001), as well as overall mortality (aHR: 1.16, 95 % CI: 1.09–1.23, P < 0.001). Afternoon surgeries were also linked to higher composite complications (adjusted odds ratio [aOR]: 1.21, 95 % CI: 1.11–1.33, P < 0.001) along with higher intensive care unit admission (aOR: 1.40, 95 % CI: 1.28–1.52, P < 0.001) and red blood cell transfusion (aOR: 1.40, 95 % CI: 1.22–1.61, P < 0.001). Surgeries starting between 3:00 and 6:00 p.m. had the highest risk of 1-year mortality (aHR: 1.33, 95 % CI: 1.15–1.54, P < 0.001) and composite complications (aOR: 1.32, 95 % CI: 1.17–1.50, P < 0.001). Seasonal analysis showed higher 30-day (aHR: 1.80, 95 % CI: 1.08–2.99, P = 0.023) and 90-day mortality (aHR: 1.32, 95 % CI: 1.00–1.74, P = 0.048) in summer, and higher overall mortality (aHR: 1.10, 95 % CI: 1.01–1.19, P = 0.030) in winter. Subgroup analyses revealed variability by surgical type.
Conclusions
Surgical start timing was significantly associated with postoperative outcomes in high-risk patients, underscoring the need for strategic scheduling.
期刊介绍:
The Journal of Clinical Anesthesia (JCA) addresses all aspects of anesthesia practice, including anesthetic administration, pharmacokinetics, preoperative and postoperative considerations, coexisting disease and other complicating factors, cost issues, and similar concerns anesthesiologists contend with daily. Exceptionally high standards of presentation and accuracy are maintained.
The core of the journal is original contributions on subjects relevant to clinical practice, and rigorously peer-reviewed. Highly respected international experts have joined together to form the Editorial Board, sharing their years of experience and clinical expertise. Specialized section editors cover the various subspecialties within the field. To keep your practical clinical skills current, the journal bridges the gap between the laboratory and the clinical practice of anesthesiology and critical care to clarify how new insights can improve daily practice.