Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
Ann Thorac Surg. 2018 Oct;106(4):1164-1170. doi: 10.1016/j.athoracsur.2018.04.062. Epub 2018 May 26.
The aim of this study was to investigate whether nighttime surgical procedures contribute to higher in-hospital mortality in patients with acute type A aortic dissection.
All patients with acute type A aortic dissection who underwent surgical procedures at Fuwai Hospital in Beijing, China from 2010 to 2015 were included in the present study. Depending on the start and end time of the surgical procedures, patients were divided in daytime and nighttime groups. Propensity-matching analysis was used to compare in-hospital mortality and postoperative complications between these groups.
A total of 698 patients with acute type A aortic dissection underwent operation. Of these, 321 (45.98%) patients underwent nighttime surgical procedures, whereas 377 (54.02%) patients underwent daytime procedures. The operation time, cardiopulmonary bypass time, and aortic cross-clamp time showed statistical differences between the two groups (p < 0.01). There was a significant difference between the daytime and nighttime groups in in-hospital mortality (6.42% vs 12.08%; p < 0.05). The nighttime group had a higher incidence rate of reintubation and continuous renal replacement therapy compared with the daytime group (p < 0.05). Furthermore, patients who underwent nighttime operations had significantly higher adjusted in-hospital mortality than patients who underwent daytime operations (odds ratio, 2.13; 95% confidence interval, 1.19 to 3.81; p = 0.01).
Patients with acute type A aortic dissection and certain serious medical conditions were more likely to die in the hospital if they underwent emergency nighttime surgical procedures.
本研究旨在探讨夜间手术是否会导致急性 A 型主动脉夹层患者住院死亡率升高。
本研究纳入 2010 年至 2015 年在中国北京阜外医院接受手术治疗的所有急性 A 型主动脉夹层患者。根据手术开始和结束时间，将患者分为日间组和夜间组。采用倾向评分匹配分析比较两组患者的住院死亡率和术后并发症。
共 698 例急性 A 型主动脉夹层患者接受手术治疗。其中 321 例（45.98%）患者行夜间手术，377 例（54.02%）患者行日间手术。两组患者的手术时间、体外循环时间和主动脉阻断时间差异均有统计学意义（p<0.01）。日间组和夜间组患者的住院死亡率差异有统计学意义（6.42%比 12.08%；p<0.05）。夜间组患者的再插管和持续肾脏替代治疗的发生率高于日间组（p<0.05）。此外，与日间手术相比，夜间手术患者的调整后住院死亡率显著升高（优势比，2.13；95%置信区间，1.19 至 3.81；p=0.01）。
对于患有急性 A 型主动脉夹层和某些严重疾病的患者，如果接受夜间紧急手术，其更有可能在医院死亡。
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