Department of Anaesthesia, Critical Care and Pain Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK.
Surgical and Perioperative Health Research (SPHeRe), University of Edinburgh, Edinburgh, UK.
Br J Surg. 2017 Jun;104(7):936-945. doi: 10.1002/bjs.10507. Epub 2017 Mar 21.
The effect of day of the week on outcome after surgery is the subject of debate. The aim was to determine whether day of the week of emergency general surgery alters short- and long-term mortality.
This was an observational study of all patients undergoing emergency general surgery in Scotland between 1 January 2005 and 31 December 2007, followed to 2012. Multilevel logistic and Cox proportional hazards regression were used to assess the effect of day of the week of surgery on outcome after adjustment for case mix and risk factors. The primary outcome was perioperative mortality; the secondary outcome was overall survival.
A total of 50 844 patients were identified, of whom 31 499 had an emergency procedure on Monday to Thursday and 19 345 on Friday to Sunday. Patients undergoing surgery at the weekend were younger (mean 45·9 versus 47·5 years; P < 0·001) and had fewer co-morbidities, but underwent riskier and/or more complex procedures (P < 0·001). Patients who had surgery at the weekend were more likely to have been operated on sooner than those who had weekday surgery (mean time from admission to operation 1·2 versus 1·6 days; P < 0·001). No difference in perioperative mortality (odds ratio 1·00, 95 per cent c.i. 0·89 to 1·13; P = 0·989) or overall survival (hazard ratio 1·01, 0·97 to 1·06; P = 0·583) was observed when surgery was performed at the weekend. There was no difference in overall survival after surgery undertaken on any particular day compared with Wednesday; a borderline reduction in perioperative mortality was seen on Tuesday.
There was no difference in short- or long-term mortality following emergency general surgery at the weekend, compared with mid-week.
手术日期对术后结果的影响一直存在争议。本研究旨在确定择期普外科手术的手术日期是否会改变短期和长期死亡率。
这是一项观察性研究，纳入了 2005 年 1 月 1 日至 2007 年 12 月 31 日期间在苏格兰接受择期普外科手术的所有患者，并随访至 2012 年。采用多水平逻辑回归和 Cox 比例风险回归，在调整病例组合和危险因素后，评估手术日期对术后结局的影响。主要结局为围手术期死亡率；次要结局为总生存率。
共纳入 50844 例患者，其中 31499 例于周一至周四行急诊手术，19345 例于周五至周日行急诊手术。周末手术的患者更年轻（平均年龄 45.9 岁 vs. 47.5 岁；P＜0.001），合并症更少，但接受的手术更具风险或更复杂（P＜0.001）。周末手术的患者比工作日手术的患者更有可能更早接受手术（平均从入院到手术的时间为 1.2 天 vs. 1.6 天；P＜0.001）。周末手术患者的围手术期死亡率（比值比 1.00，95%置信区间 0.89 至 1.13；P=0.989）或总生存率（风险比 1.01，0.97 至 1.06；P=0.583）与工作日手术无差异。与周三相比，在任何特定日子行手术的患者的总生存率无差异；周二时围手术期死亡率略有下降。
与一周中其他日子相比，周末行择期普外科手术不会增加短期或长期死亡率。
