Department of Anaesthesiology, Medical Faculty, RWTH Aachen University, Aachen, Germany.
Department of Anaesthesiology and Operative Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany.
Anaesthesia. 2018 Jun;73(6):711-718. doi: 10.1111/anae.14228. Epub 2018 Feb 23.
Studies that have investigated circadian, weekday and seasonal variation in postoperative mortality have been relatively small or have been for scheduled surgery. We retrospectively tested a large mixed surgical cohort from a German tertiary care university hospital for the presence of cyclical variation in all-cause in-hospital mortality after operations performed between 2006 and 2013. We analysed mortality rates after 247,475 operations, adjusted for age, sex, comorbidities, location, urgency and duration of the surgery, and intra-operative blood transfusions. The mortality odds ratio (95%CI) after operations started in the morning (08:00-11:00) were lowest, 0.73 (0.66-0.80), p < 0.001 and highest for operations started in the afternoon (13:00-17:00), 1.29 (1.18-1.40), p < 0.001. Mortality at the weekend was the same as during the week. There was no seasonal variation in mortality, p = 0.12. However, the interference of four-yearly and ten-monthly cycle amplitudes resulted in higher mortality odds ratio (95%CI) in winter 2008-2009, 1.41 (1.18-1.69), p < 0.001, and lower mortality in spring 2011 and 2012, 0.70 (0.56-0.85) and 0.67 (0.53-0.85), p < 0.001 and p = 0.001, respectively. The ability to predict cyclical phenomena would facilitate the design of interventional studies, aimed at reducing mortality following surgery in the afternoon and when cycles interfere constructively.
研究已经调查了术后死亡率的昼夜、工作日和季节性变化，但这些研究相对较小，或者是针对计划手术的。我们回顾性地测试了一家德国三级护理大学医院的一个大型混合手术队列，以检验 2006 年至 2013 年期间进行的所有手术的全因住院死亡率是否存在周期性变化。我们分析了 247475 例手术后的死亡率，调整了年龄、性别、合并症、手术地点、紧急情况和持续时间以及术中输血等因素。早上（08:00-11:00）开始手术的死亡率最低，为 0.73（0.66-0.80），p<0.001，下午（13:00-17:00）开始手术的死亡率最高，为 1.29（1.18-1.40），p<0.001。周末的死亡率与一周内相同。死亡率没有季节性变化，p=0.12。然而，四年和十个月的周期幅度的干扰导致 2008-2009 年冬季的死亡率更高，为 1.41（1.18-1.69），p<0.001，而 2011 年和 2012 年春季的死亡率较低，分别为 0.70（0.56-0.85）和 0.67（0.53-0.85），p<0.001 和 p=0.001。预测周期性现象的能力将有助于设计干预性研究，旨在降低下午和周期建设性干扰时手术的死亡率。
