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Observational Study
. 2019 Mar;122(3):361-369.
doi: 10.1016/j.bja.2018.10.063. Epub 2019 Feb 8.

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

A Cortegiani  1 , C Gregoretti  2 , A S Neto  3 , S N T Hemmes  4 , L Ball  5 , J Canet  6 , M Hiesmayr  7 , M W Hollmann  8 , G H Mills  9 , M F V Melo  10 , C Putensen  11 , W Schmid  7 , P Severgnini  12 , H Wrigge  13 , M Gama de Abreu  14 , M J Schultz  15 , P Pelosi  5 ; LAS VEGAS Investigators, the PROVE Network, and the Clinical Trial Network of the European Society of Anaesthesiology
Collaborators, Affiliations
Free article
Observational Study

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

A Cortegiani et al. Br J Anaesth. 2019 Mar.
Free article

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.

Clinical trial registration: NCT01601223.

Keywords: general anaesthesia; intraoperative complications; patient safety; postoperative complications; pulmonary.

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