Dalton Michael K, McDonald Elizabeth, Bhatia Pulkesh, Davis Kimberly A, Schuster Kevin M
Department of Surgery, Yale School of Medicine, 330 Cedar Street BB 310, PO Box 208062, New Haven, CT 86520-8062, USA.
Department of Surgery, Yale School of Medicine, 330 Cedar Street BB 310, PO Box 208062, New Haven, CT 86520-8062, USA.
Am J Surg. 2016 Nov;212(5):831-836. doi: 10.1016/j.amjsurg.2016.02.024. Epub 2016 May 11.
Acute care surgeons operate during the day and night. Time of day or night may impact the outcome because of surgeon and team fatigue, operative delays, or other unmeasured factors.
We performed matched retrospective cohort study of patients undergoing operative intervention at night by acute care surgeons over 16 months. Cases were matched on case complexity, age, and sex to daytime cases. Other confounders including comorbidities, presenting characteristics, complications, and mortality were abstracted. Outcomes differences between day and night cases were compared.
Night cases (115) were matched 1:1 to daytime cases. Groups had similar degrees of comorbidity. Those operated at night had trends toward more hypotension and sepsis. After controlling for confounders using conditional logistic regression, surgical care at night was a potent predictor of mortality (odds ratio 30.02; 95% CI 2.33 to 387.40; P = .009) but had little impact on morbidity (odds ratio 1.34; 95% CI .77 to 2.36; P = .303).
Emergency operations performed at night by acute care surgeons may have dissimilar outcomes compared with day cases.
急性病外科医生日夜都要进行手术。由于外科医生和团队疲劳、手术延迟或其他未测量的因素，白天或晚上的时间可能会影响手术结果。
我们对急性病外科医生在16个月内夜间进行手术干预的患者进行了匹配的回顾性队列研究。根据病例复杂性、年龄和性别将病例与白天的病例进行匹配。提取其他混杂因素，包括合并症、临床表现、并发症和死亡率。比较白天和夜间病例的结果差异。
夜间病例（115例）与白天病例1:1匹配。两组的合并症程度相似。夜间手术的患者出现低血压和败血症的趋势更高。在使用条件逻辑回归控制混杂因素后，夜间手术护理是死亡率的有力预测因素（比值比30.02；95%可信区间2.33至387.40；P = 0.009），但对发病率影响不大（比值比1.34；95%可信区间0.77至2.36；P = 0.303）。
与白天的病例相比，急性病外科医生在夜间进行的急诊手术可能有不同的结果。
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