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

A. Cortegiani; C. Gregoretti; A. S. Neto; S. N.T. Hemmes; L. Ball; J. Canet; W. Schmid; P. Severgnini; H. Wrigge; M. Gama de Abreu; M. J. Schultz; P. Pelosi; LAS VEGAS Investigators, the PROVE Network, and the Clinical Trial Network of the European Society of Anaesthesiology

doi:10.1016/j.bja.2018.10.063

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

A. Cortegiani^*, C. Gregoretti, A. S. Neto, S. N.T. Hemmes, L. Ball, J. Canet, W. Schmid, P. Severgnini, H. Wrigge, M. Gama de Abreu, M. J. Schultz, P. Pelosi, LAS VEGAS Investigators, the PROVE Network, and the Clinical Trial Network of the European Society of Anaesthesiology

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

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.

Original language	English
Pages (from-to)	361-369
Number of pages	9
Journal	British Journal of Anaesthesia
Volume	122
Issue number	3
Early online date	2018
DOIs	https://doi.org/10.1016/j.bja.2018.10.063
Publication status	Published - 1 Mar 2019

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10.1016/j.bja.2018.10.063

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Cortegiani, A., Gregoretti, C., Neto, A. S., Hemmes, S. N. T., Ball, L., Canet, J., ... LAS VEGAS Investigators, the PROVE Network, and the Clinical Trial Network of the European Society of Anaesthesiology (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

Cortegiani, A. ; Gregoretti, C. ; Neto, A. S. ; Hemmes, S. N.T. ; Ball, L. ; Canet, J. ; Schmid, W. ; Severgnini, P. ; Wrigge, H. ; Gama de Abreu, M. ; Schultz, M. J. ; Pelosi, P. ; LAS VEGAS Investigators, the PROVE Network, and the Clinical Trial Network of the European Society of Anaesthesiology. / Association between night-time surgery and occurrence of intraoperative adverse events and postoperative pulmonary complications. In: British Journal of Anaesthesia. 2019 ; Vol. 122, No. 3. pp. 361-369.

@article{2483cfcc95954edbad90f4b1d91d5d0d,

title = "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{\%}; 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",

author = "A. Cortegiani and C. Gregoretti and Neto, {A. S.} and Hemmes, {S. N.T.} and L. Ball and J. Canet and M. Hiesmayr and Hollmann, {M. W.} and Mills, {G. H.} and Melo, {M. F.V.} and C. Putensen and W. Schmid and P. Severgnini and H. Wrigge and {Gama de Abreu}, M. and Schultz, {M. J.} and P. Pelosi and W. Kroell and H. Metzler and G. Struber and T. Wegscheider and H. Gombotz and B. Urbanek and D. Kahn and M. Momeni and A. Pospiech and F. Lois and P. Forget and I. Grosu and J. Poelaert and V. Mossevelde and {van Malderen}, {M. C.} and D. Dylst and Melkebeek, {J. V.} and M. Beran and Hert, {S. D.} and Baerdemaeker, {L. D.} and B. Heyse and Limmen, {J. V.} and P. Wyffels and T. Jacobs and N. Roels and Bruyne, {A. D.} and Velde, {S. V.D.} and Marina, {J. Z.} and Dejana, {D. O.} and S. Pernar and J. Zunic and P. Miskovic and A. Zilic and S. Kvolik and D. Ivic and Darija, {A. V.} and S. Skiljic and H. Vinkovic and I. Oputric and K. Juricic and V. Frkovic and J. Kopic and I. Mirkovic and Saric, {J. P.} and G. Erceg and Dvorscak, {M. B.} and Branka, {M. S.} and Pavicic, {A. M.} and T. Goranovic and B. Maldini and T. Radocaj and Z. Gavranovic and Inga, {M. B.} and M. Sehovic and P. Stourac and H. Harazim and O. Smekalova and M. Kosinova and T. Kolacek and K. Hudacek and M. Drab and J. Brujevic and K. Vitkova and K. Jirmanova and I. Volfova and P. Dzurnakova and K. Liskova and R. Dudas and R. Filipsky and Kafrawy, {S. E.} and Abdelwahab, {H. H.} and T. Metwally and Ahmed, {A. R.} and {Ahmed Mostafa}, {E. S.} and Hasan, {W. F.} and Ahmed, {A. G.} and H. Yassin and M. Magdy and M. Abdelhady and M. Mahran and E. Herodes and P. Kivik and J. Oganjan and A. Aun and A. Sormus and K. Sarapuu and M. Mall and J. Karjagin and E. Futier and A. Petit and A. Gerard and E. Marret and M. Solier and S. Jaber and A. Prades and J. Krassler and S. Merzky and Abreu, {M. G.D.} and C. Uhlig and T. Kiss and A. Bundy and T. Bluth and A. Gueldner and P. Spieth and M. 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Defez and {Cesar Aldecoa}, {A. S.} and R. Perez and J. Rico and M. Jawad and Y. Saeed and L. Gillberg and Bengisun, {Z. K.} and Kazbek, {B. K.} and N. Coskunfirat and N. Boztug and S. Sanli and M. Yilmaz and N. Hadimioglu and Senturk, {N. M.} and E. Camci and S. Kucukgoncu and Z. Sungur and N. Sivrikoz and Ozgen, {S. U.} and F. Toraman and O. Selvi and O. Senturk and M. Yildiz and B. Kuvaki and F. Gunenc and S. Kucukguclu and S. Ozbilgin and J. Maral and S. Canli and O. Arun and A. Saltali and E. Aydogan and Akgun, {F. N.} and C. Sanlikarip and Karaman, {F. M.} and A. Mazur and S. Vorotyntsev and G. Rousseau and C. Barrett and L. Stancombe and B. Shelley and H. Scholes and J. Limb and A. Rafi and L. Wayman and J. Deane and D. Rogerson and J. Williams and S. Yates and E. Rogers and M. Pulletz and S. Moreton and S. Jones and S. Venkatesh and M. Burton and L. Brown and C. Goodall and M. Rucklidge and D. Fuller and M. Nadolski and S. Kusre and M. Lundberg and L. Everett and H. Nutt and M. 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year = "2019",

month = "3",

day = "1",

doi = "10.1016/j.bja.2018.10.063",

language = "English",

volume = "122",

pages = "361--369",

journal = "British Journal of Anaesthesia",

issn = "0007-0912",

publisher = "Oxford University Press",

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Cortegiani, A, Gregoretti, C, Neto, AS, Hemmes, SNT, Ball, L, Canet, J, Schmid, W, Severgnini, P, Wrigge, H, Gama de Abreu, M, Schultz, MJ, Pelosi, P & LAS VEGAS Investigators, the PROVE Network, and the Clinical Trial Network of the European Society of Anaesthesiology 2019, 'Association between night-time surgery and occurrence of intraoperative adverse events and postoperative pulmonary complications', British Journal of Anaesthesia, vol. 122, no. 3, pp. 361-369. https://doi.org/10.1016/j.bja.2018.10.063

Association between night-time surgery and occurrence of intraoperative adverse events and postoperative pulmonary complications. / Cortegiani, A.; Gregoretti, C.; Neto, A. S.; Hemmes, S. N.T.; Ball, L.; Canet, J.; Schmid, W.; Severgnini, P.; Wrigge, H.; Gama de Abreu, M.; Schultz, M. J.; Pelosi, P.; LAS VEGAS Investigators, the PROVE Network, and the Clinical Trial Network of the European Society of Anaesthesiology.

In: British Journal of Anaesthesia, Vol. 122, No. 3, 01.03.2019, p. 361-369.

Research output: Contribution to journal › Article › Academic › peer-review

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AU - Cortegiani, A.

AU - Gregoretti, C.

AU - Neto, A. S.

AU - Hemmes, S. N.T.

AU - Ball, L.

AU - Canet, J.

AU - Hiesmayr, M.

AU - Hollmann, M. W.

AU - Mills, G. H.

AU - Melo, M. F.V.

AU - Putensen, C.

AU - Schmid, W.

AU - Severgnini, P.

AU - Wrigge, H.

AU - Gama de Abreu, M.

AU - Schultz, M. J.

AU - Pelosi, P.

AU - Kroell, W.

AU - Metzler, H.

AU - Struber, G.

AU - Wegscheider, T.

AU - Gombotz, H.

AU - Urbanek, B.

AU - Kahn, D.

AU - Momeni, M.

AU - Pospiech, A.

AU - Lois, F.

AU - Forget, P.

AU - Grosu, I.

AU - Poelaert, J.

AU - Mossevelde, V.

AU - van Malderen, M. C.

AU - Dylst, D.

AU - Melkebeek, J. V.

AU - Beran, M.

AU - Hert, S. D.

AU - Baerdemaeker, L. D.

AU - Heyse, B.

AU - Limmen, J. V.

AU - Wyffels, P.

AU - Jacobs, T.

AU - Roels, N.

AU - Bruyne, A. D.

AU - Velde, S. V.D.

AU - Marina, J. Z.

AU - Dejana, D. O.

AU - Pernar, S.

AU - Zunic, J.

AU - Miskovic, P.

AU - Zilic, A.

AU - Kvolik, S.

AU - Ivic, D.

AU - Darija, A. V.

AU - Skiljic, S.

AU - Vinkovic, H.

AU - Oputric, I.

AU - Juricic, K.

AU - Frkovic, V.

AU - Kopic, J.

AU - Mirkovic, I.

AU - Saric, J. P.

AU - Erceg, G.

AU - Dvorscak, M. B.

AU - Branka, M. S.

AU - Pavicic, A. M.

AU - Goranovic, T.

AU - Maldini, B.

AU - Radocaj, T.

AU - Gavranovic, Z.

AU - Inga, M. B.

AU - Sehovic, M.

AU - Stourac, P.

AU - Harazim, H.

AU - Smekalova, O.

AU - Kosinova, M.

AU - Kolacek, T.

AU - Hudacek, K.

AU - Drab, M.

AU - Brujevic, J.

AU - Vitkova, K.

AU - Jirmanova, K.

AU - Volfova, I.

AU - Dzurnakova, P.

AU - Liskova, K.

AU - Dudas, R.

AU - Filipsky, R.

AU - Kafrawy, S. E.

AU - Abdelwahab, H. H.

AU - Metwally, T.

AU - Ahmed, A. R.

AU - Ahmed Mostafa, E. S.

AU - Hasan, W. F.

AU - Ahmed, A. G.

AU - Yassin, H.

AU - Magdy, M.

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AU - Herodes, E.

AU - Kivik, P.

AU - Oganjan, J.

AU - Aun, A.

AU - Sormus, A.

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AU - Mall, M.

AU - Karjagin, J.

AU - Futier, E.

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AU - Simon, P.

AU - Reske, A.

AU - Nestler, C.

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AU - Andreou, A.

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AU - Tasoulis, M. K.

AU - Sidiropoulou, T.

AU - Zafeiropoulou, F.

AU - Florou, P.

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AU - Tsaousi, G.

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AU - Pourzitaki, C.

AU - Bystritski, D.

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AU - Campanile, A.

AU - Marrella, A.

AU - Grasso, S.

AU - Michele, M. D.

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AU - Sottosanti, L. G.V.

AU - Solca, M.

AU - Volta, C. A.

AU - Spadaro, S.

AU - Verri, M.

AU - Ragazzi, R.

AU - Zoppellari, R.

AU - Cinnella, G.

AU - Raimondo, P.

AU - Bella, D. L.

AU - Mirabella, L.

AU - D'antini, D.

AU - Molin, A.

AU - Brunetti, I.

AU - Gratarola, A.

AU - Pellerano, G.

AU - Sileo, R.

AU - Pezzatto, S.

AU - Montagnani, L.

AU - Pasin, L.

AU - Landoni, G.

AU - Zangrillo, A.

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AU - Parma, A. L.D.

AU - Tarzia, V.

AU - Dossi, R.

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AU - Tredici, S.

AU - Spano, G.

AU - Castellani, G.

AU - Delunas, L.

AU - Peradze, S.

AU - Venturino, M.

AU - Arpino, I.

AU - Sher, S.

AU - Tommasino, C.

AU - Rapido, F.

AU - Morelli, P.

AU - Vargas, M.

AU - Servillo, G.

AU - Raineri, S. M.

AU - Montalto, F.

AU - Russotto, V.

AU - Giarratano, A.

AU - Baciarello, M.

AU - Generali, M.

AU - Cerati, G.

AU - Leykin, Y.

AU - Bressan, F.

AU - Bartolini, V.

AU - Zamidei, L.

AU - Brazzi, L.

AU - Liperi, C.

AU - Sales, G.

AU - Pistidda, L.

AU - Brugnoni, E.

AU - Musella, G.

AU - Bacuzzi, A.

AU - Muhardri, D.

AU - Agreta, G. G.

AU - Sada, F.

AU - Bytyqi, A.

AU - Karbonskiene, A.

AU - Aukstakalniene, R.

AU - Teberaite, Z.

AU - Salciute, E.

AU - Tikuisis, R.

AU - Miliauskas, P.

AU - Jurate, S.

AU - Kontrimaviciute, E.

AU - Tomkute, G.

AU - Xuereb, J.

AU - Bezzina, M.

AU - Borg, F. Joseph

AU - Hemmes, S.

AU - Schultz, M.

AU - Hollmann, M.

AU - Wiersma, I.

AU - Binnekade, J.

AU - Bos, L.

AU - Boer, C.

AU - Duvekot, A.

AU - Veld, B. I.‘t

AU - Werger, A.

AU - Dennesen, P.

AU - Severijns, C.

AU - Jong, J. D.

AU - Hering, J.

AU - Beek, R. V.

AU - Ivars, S.

AU - Jammer, I. B.

AU - Breidablik, A.

AU - Hodt, K. S.

AU - Fjellanger, F.

AU - Avalos, M. V.

AU - Jannicke, M. O.

AU - Andersson, E.

AU - Amir, S. K.

AU - Molina, R.

AU - Wutai, S.

AU - Morais, E.

AU - Tareco, G.

AU - Ferreira, D.

AU - Amaral, J.

AU - Castro, M. D.L.G.

AU - Cadilha, S.

AU - Appleton, S.

AU - Parente, S.

AU - Correia, M.

AU - Martins, D.

AU - Monteirosa, A.

AU - Ricardo, A.

AU - Rodrigues, S.

AU - Horhota, L.

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AU - Tze, Y.

AU - LAS VEGAS Investigators, the PROVE Network, and the Clinical Trial Network of the European Society of Anaesthesiology

PY - 2019/3/1

Y1 - 2019/3/1

N2 - 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.

AB - 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.

KW - general anaesthesia

KW - intraoperative complications

KW - patient safety

KW - postoperative complications

KW - pulmonary

UR - http://www.scopus.com/inward/record.url?scp=85058784675&partnerID=8YFLogxK

U2 - 10.1016/j.bja.2018.10.063

DO - 10.1016/j.bja.2018.10.063

M3 - Article

C2 - 30770054

VL - 122

SP - 361

EP - 369

JO - British Journal of Anaesthesia

JF - British Journal of Anaesthesia

SN - 0007-0912

IS - 3

ER -