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, 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. Struber & 31 others T. 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, M. Weiss, C. Boer, A. Duvekot, LAS VEGAS Investigators, the PROVE Network, and the Clinical Trial Network of the European Society of Anaesthesiology

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 languageEnglish
Pages (from-to)361-369
Number of pages9
JournalBritish Journal of Anaesthesia
Volume122
Issue number3
Early online date2018
DOIs
Publication statusPublished - 1 Mar 2019

Cite this

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. ; 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. ; Struber, G. ; Wegscheider, T. ; Gombotz, H. ; Urbanek, B. ; Kahn, D. ; Momeni, M. ; Pospiech, A. ; Lois, F. ; Forget, P. ; Grosu, I. ; Poelaert, J. ; Mossevelde, V. ; van Malderen, M. C. ; Dylst, D. ; Melkebeek, J. V. ; Beran, M. ; Hert, S. D. ; Baerdemaeker, L. D. ; Heyse, B. ; Limmen, J. V. ; Wyffels, P. ; Jacobs, T. ; Roels, N. ; Bruyne, A. D. ; Velde, S. V. D. ; Marina, J. Z. ; Dejana, D. O. ; Pernar, S. ; Weiss, M. ; Boer, C. ; Duvekot, A. ; 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 M. Weiss and C. Boer and A. Duvekot and {LAS VEGAS Investigators, the PROVE Network, and the Clinical Trial Network of the European Society of Anaesthesiology}",
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",
number = "3",

}

Cortegiani, A, Gregoretti, C, Neto, AS, Hemmes, SNT, Ball, L, Canet, J, Hiesmayr, M, Hollmann, MW, Mills, GH, Melo, MFV, Putensen, C, Schmid, W, Severgnini, P, Wrigge, H, Gama de Abreu, M, Schultz, MJ, Pelosi, P, Kroell, W, Metzler, H, Struber, G, Wegscheider, T, Gombotz, H, Urbanek, B, Kahn, D, Momeni, M, Pospiech, A, Lois, F, Forget, P, Grosu, I, Poelaert, J, Mossevelde, V, van Malderen, MC, Dylst, D, Melkebeek, JV, Beran, M, Hert, SD, Baerdemaeker, LD, Heyse, B, Limmen, JV, Wyffels, P, Jacobs, T, Roels, N, Bruyne, AD, Velde, SVD, Marina, JZ, Dejana, DO, Pernar, S, Weiss, M, Boer, C, Duvekot, A & 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.; 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.; Struber, G.; Wegscheider, T.; Gombotz, H.; Urbanek, B.; Kahn, D.; Momeni, M.; Pospiech, A.; Lois, F.; Forget, P.; Grosu, I.; Poelaert, J.; Mossevelde, V.; van Malderen, M. C.; Dylst, D.; Melkebeek, J. V.; Beran, M.; Hert, S. D.; Baerdemaeker, L. D.; Heyse, B.; Limmen, J. V.; Wyffels, P.; Jacobs, T.; Roels, N.; Bruyne, A. D.; Velde, S. V. D.; Marina, J. Z.; Dejana, D. O.; Pernar, S.; Weiss, M.; Boer, C.; Duvekot, A.; 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

TY - JOUR

T1 - Association between night-time surgery and occurrence of intraoperative adverse events and postoperative pulmonary complications

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 - Weiss, M.

AU - Boer, C.

AU - Duvekot, A.

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 - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85058784675&origin=inward

U2 - 10.1016/j.bja.2018.10.063

DO - 10.1016/j.bja.2018.10.063

M3 - Article

VL - 122

SP - 361

EP - 369

JO - British Journal of Anaesthesia

JF - British Journal of Anaesthesia

SN - 0007-0912

IS - 3

ER -

Cortegiani A, Gregoretti C, Neto AS, Hemmes SNT, Ball L, Canet J et al. Association between night-time surgery and occurrence of intraoperative adverse events and postoperative pulmonary complications. British Journal of Anaesthesia. 2019 Mar 1;122(3):361-369. https://doi.org/10.1016/j.bja.2018.10.063

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