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

IF 5.1 2区 医学 Q1 ANESTHESIOLOGY
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.
每日、每周和季节性手术时间对高危非心脏手术患者术后结局的影响:一项回顾性单中心研究
背景关于高危患者手术开始时间对预后影响的知识有限。本研究评估其与选择性非心脏手术的死亡率、发病率和医疗资源利用的关系。方法回顾性队列研究纳入2012 - 2021年在某三级医疗中心择期行非心脏手术的高危患者(ASA≥3)14394例。根据手术开始时间将患者分组为详细的时间间隔(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.)和更广泛的时间段(上午vs下午)。每周(周一-周三vs.周四-周五)和季节性(春、夏、秋、冬)的变化进行了分析。Cox和logistic回归模型评估了死亡率、并发症和医疗保健利用率。结果下午手术与90天(校正风险比[aHR]: 1.28, 95%可信区间[CI]: 1.05 ~ 1.57, P = 0.016)、180天(aHR: 1.30, 95% CI: 1.12 ~ 1.51, P <;0.001), 1年(aHR: 1.26, 95% CI: 1.13—-1.40,P & lt;0.001),以及总死亡率(aHR: 1.16, 95% CI: 1.09-1.23, P <;0.001)。下午手术也与较高的复合并发症相关(调整优势比[aOR]: 1.21, 95% CI: 1.11-1.33, P <;0.001)以及更高的重症监护病房入院率(aOR: 1.40, 95% CI: 1.28-1.52, P <;0.001)和红细胞输注(aOR: 1.40, 95% CI: 1.22-1.61, P <;0.001)。在下午3点到6点之间开始手术的患者1年死亡率最高(aHR: 1.33, 95% CI: 1.15-1.54, P <;0.001)和复合并发症(aOR: 1.32, 95% CI: 1.17-1.50, P <;0.001)。季节分析显示,夏季30天死亡率(aHR: 1.80, 95% CI: 1.08 ~ 2.99, P = 0.023)和90天死亡率(aHR: 1.32, 95% CI: 1.00 ~ 1.74, P = 0.048)较高,冬季总死亡率(aHR: 1.10, 95% CI: 1.01 ~ 1.19, P = 0.030)较高。亚组分析显示不同手术类型的差异。结论高危患者手术开始时间与术后预后显著相关,强调有策略地安排手术时间的必要性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
7.40
自引率
4.50%
发文量
346
审稿时长
23 days
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.
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