Division of Cardiology, Veterans Administration Medical Center, One Veterans Drive, Minneapolis, Minnesota 55417, USA.
BMC Cardiovasc Disord. 2011 Oct 20;11:63. doi: 10.1186/1471-2261-11-63.
Mortality and complications after percutaneous coronary intervention is higher when performed after regular duty hours due to challenging patient characteristics, inferior processes of care and limited resources. Since these challenges are also encountered during coronary artery bypass graft (CABG) surgery that is performed after regular work hours, we assessed whether hour and day of procedure influenced mortality after CABG.
We studied 4,714 consecutive patients who underwent CABG at the Minneapolis Veterans Administration (VA) Medical Center between 1987 and 2009. We compared postoperative (30-day) mortality rates in relation to hour and day in which the operation was performed.
Operations performed on weekends and after 4 PM had higher risk patients (p < 0.0001) and were more likely to be emergent (p < 0.0001), require intra-aortic balloon pump support (p < 0.0001) and result in postoperative complications (p < 0.0001) compared to those at regular work hours. Mortality was significantly higher when CABG was performed on weekends compared to weekdays (9.4% versus 2.5%; odds ratio (OR) 4.1, 95% confidence interval (CI) 1.6 to 10.4, p = 0.003), and after 4 PM compared to between 7 AM-4 PM (6.2% versus 2.2%; OR 2.9, 95% CI 1 to 8, p = 0.049). In multivariable analysis, when adjusted for the urgency of the operation and the VA estimated mortality risk score, these associations were no longer statistically significant.
Mortality after CABG is higher when surgery is performed on the weekends and after 4 PM. These variations in mortality were related to higher patient risk, and urgency of the operation rather than external factors.
由于患者特征具有挑战性、护理流程较差以及资源有限，经皮冠状动脉介入治疗（PCI）在常规工作时间后进行时，死亡率和并发症较高。由于这些挑战在常规工作时间后进行的冠状动脉旁路移植术（CABG）中也会遇到，因此我们评估了手术时间和日期是否会影响 CABG 后的死亡率。
我们研究了 1987 年至 2009 年间在明尼苏达州退伍军人事务部（VA）医疗中心接受 CABG 的 4714 例连续患者。我们比较了手术时间与术后 30 天死亡率之间的关系。
周末和下午 4 点以后进行的手术风险更高的患者（p<0.0001），更有可能是紧急手术（p<0.0001），需要主动脉内球囊泵支持（p<0.0001），并导致术后并发症（p<0.0001）与常规工作时间相比。与平日相比，周末进行 CABG 的死亡率明显更高（9.4%对 2.5%；优势比（OR）4.1，95%置信区间（CI）1.6 至 10.4，p=0.003），下午 4 点以后进行的死亡率高于上午 7 点至下午 4 点之间进行的手术（6.2%对 2.2%；OR 2.9，95%CI 1 至 8，p=0.049）。多变量分析调整手术的紧急程度和 VA 估计死亡率评分后，这些关联不再具有统计学意义。
周末和下午 4 点以后进行 CABG 手术的死亡率更高。这些死亡率的差异与患者风险较高和手术紧急程度有关，而与外部因素无关。
