Dalén Magnus, Edgren Gustaf, Ivert Torbjörn, Holzmann Martin J, Sartipy Ulrik
Section of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden.
Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
J Am Heart Assoc. 2017 May 16;6(5):e005908. doi: 10.1161/JAHA.117.005908.
The purpose of this study was to investigate the association between weekday of surgery and survival following cardiac surgery.
In a nationwide cohort study, we included all patients who underwent cardiac surgery in 1999-2013 from the SWEDEHEART (Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies) register. All-cause mortality until March 2014 was obtained from national registers. The association between weekday of surgery and mortality was estimated using Cox regression, and reported as hazard ratios with 95% CI. We used the restricted mean survival time difference to estimate loss of life related to weekday of surgery. Among 106 473 patients, 25 221 (24%), 24 471 (23%), 22 977 (22%), 20 189 (19%), 9251 (8.7%), and 4364 (4.1%) underwent surgery during a Monday, Tuesday, Wednesday, Thursday, Friday, and a Saturday/Sunday, respectively. More patients were operated on urgently during Friday to Sunday, and unadjusted analyses showed higher early and late mortality in those patients. The adjusted hazard ratios (95% CI) were 1.00 (0.89-1.13), 1.00 (0.88-1.12), 1.02 (0.90-1.16), 1.17 (1.01-1.37), and 1.05 (0.86-1.29) in patients who underwent surgery during a Tuesday, Wednesday, Thursday, Friday, and Saturday/Sunday compared to a Monday, after 1 year of follow-up conditional on 30-day survival. In elective surgery (n=46 146), the 1-year restricted mean survival time difference (95% CI) was -0.5 (-1.8-0.8), -0.5 (-1.9-0.8), -1.0 (-2.6-0.5), 0.02 (-2.2-2.3), and -1.2 (-6.3-3.9) days in patients who underwent surgery during a Tuesday, Wednesday, Thursday, Friday, and a Saturday/Sunday, respectively, compared to a Monday.
We found no evidence of a clinically relevant weekday effect in patents who underwent cardiac surgery in Sweden during a 15-year period. These data suggest that the early risk and long-term prognosis following cardiac surgery was not affected by the weekday of surgery.
URL: http://www.clinicaltrials.gov. Unique identifier: NCT02276950.
本研究旨在调查心脏手术后手术日期与生存率之间的关联。
在一项全国性队列研究中，我们纳入了1999年至2013年期间在瑞典心脏疾病循证护理增强与发展网络系统（SWEDEHEART）登记处接受心脏手术的所有患者。从国家登记处获取截至2014年3月的全因死亡率。使用Cox回归估计手术日期与死亡率之间的关联，并报告为具有95%置信区间的风险比。我们使用受限平均生存时间差来估计与手术日期相关的生命损失。在106473例患者中，分别有25221例（24%）、24471例（23%）、22977例（22%）、20189例（19%）、9251例（8.7%）和4364例（4.1%）在周一、周二、周三、周四、周五以及周六/周日接受手术。周五至周日期间接受急诊手术的患者更多，未经调整的分析显示这些患者的早期和晚期死亡率更高。在30天存活的条件下进行1年随访后，与周一接受手术的患者相比，周二、周三、周四、周五以及周六/周日接受手术的患者调整后的风险比（95%置信区间）分别为1.00（0.89 - 1.13）、1.00（0.88 - 1.12）、1.02（0.90 - 1.16）、1.17（1.01 - 1.37）和1.05（0.86 - 1.29）。在择期手术（n = 46146）中，与周一接受手术的患者相比，周二、周三、周四、周五以及周六/周日接受手术的患者1年受限平均生存时间差（95%置信区间）分别为 -0.5（-1.8 - 0.8）天、-0.5（-1.9 - 0.8）天、-1.0（-2.6 - 0.5）天、0.02（-2.2 - 2.3）天和 -1.2（-6.3 - 3.9）天。
我们没有发现证据表明在15年期间于瑞典接受心脏手术的患者中存在具有临床意义的手术日期效应。这些数据表明心脏手术后的早期风险和长期预后不受手术日期的影响。
