Department of Anesthesiology, University Hospitals Leuven, Leuven, Belgium.
Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium.
Transplant Rev (Orlando). 2018 Jul;32(3):168-177. doi: 10.1016/j.trre.2018.05.001. Epub 2018 May 8.
Transplant procedures are frequently performed outside the regular working hours (after hours). In general surgery, several studies observed worse outcomes for operations performed after hours. The predetermined hypothesis was that patients undergoing transplantation during after hours might suffer from an excess in post-operative mortality and morbidity when compared to patients undergoing transplantations during the regular working hours. A systematic review of the PubMed database identified 11,993 records, of which eleven cohort studies including a total of 287,741 patients investigated the association between the starting time of transplant surgery and postoperative mortality (primary outcome) and/or morbidity (secondary outcome). Eight studies evaluated kidney transplants (in 165,277 patients), two studies analyzed liver transplants (in 95,346 patients), and one study investigated transplantations of thoracic organs (in 27,118 patients). Results were conflicting with two studies (in liver and lung transplantation) showing an increased mortality for transplantations performed after hours, and five studies showing no effects on mortality. A meta-analysis on estimates from four studies yielded a hazard ratio of 1.01 (95% CI, 0.98 to 1.04) for mortality comparing transplantations performed during versus outside the regular working hours. The evidence was also inconclusive for a variety of morbidity outcomes with studies demonstrating either a deterioration of outcome, no effect or an improved outcome for after hours procedures. On the basis of the available evidence, it appears impossible to give an unequivocal recommendation regarding starting times in transplant surgery.
移植手术经常在正常工作时间（下班后）之外进行。在普通外科中，有几项研究观察到，在下班后进行的手术结果较差。预先假设是，与在正常工作时间进行移植手术的患者相比，在下班后接受移植的患者在术后死亡率和发病率方面可能会过高。对 PubMed 数据库的系统评价确定了 11993 条记录，其中 11 项队列研究共纳入了 287741 名患者，研究了移植手术开始时间与术后死亡率（主要结局）和/或发病率（次要结局）之间的关系。8 项研究评估了肾移植（165277 名患者），2 项研究分析了肝移植（95346 名患者），1 项研究调查了胸部器官移植（27118 名患者）。结果存在冲突，有两项研究（肝和肺移植）显示下班后进行的移植手术死亡率增加，有五项研究显示死亡率无影响。对四项研究的估计值进行荟萃分析，结果显示在正常工作时间内外进行的移植手术相比，死亡率的危险比为 1.01（95%CI，0.98 至 1.04）。对于各种发病率结局，研究结果也不一致，有些研究表明结果恶化，有些研究表明无影响，有些研究表明下班后手术的结果有所改善。根据现有证据，似乎不可能对移植手术的开始时间给出明确的建议。
