Department of Medicine, ABC Medical College University Center, Santo André, São Paulo, Brazil.
Unidade de Medicina Interdisciplinar em Cardiologia, Instituto do Coração, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, São Paulo, Brasil.
PLoS One. 2023 Jan 5;18(1):e0279873. doi: 10.1371/journal.pone.0279873. eCollection 2023.
Conflicting results are reported about daytime variation on mortality and cardiac outcomes after non-cardiac surgeries. In this cohort study, we evaluate whether the period of the day in which surgeries are performed may influence all-cause mortality and cardiovascular outcomes in patients undergoing non-cardiac arterial vascular procedures.
1,267 patients who underwent non-cardiac arterial vascular surgeries between 2012 and 2018 were prospectively included in our cohort and categorized into two groups: morning (7 a.m. to 12 a.m., 79%) and afternoon/night (12:01 p.m. to 6:59 a.m. in the next day, 21%) surgeries. Primary endpoint was all-cause mortality within 30 days and one year. Secondary endpoints were the incidence of perioperative myocardial injury/infarction (PMI), and the incidence of major adverse cardiac events (MACE, including acute myocardial infarction, acute heart failure, arrhythmias, cardiovascular death) at hospital discharge.
After adjusting for confounders in the multivariable Cox proportional regression, all-cause mortality rates at 30 days and one year were higher among those who underwent surgery in the afternoon/night (aHR 1.6 [95%CI 1.1-2.3], P = 0.015 and aHR 1.7 [95%CI 1.3-2.2], P < 0.001, respectively). Afternoon/night patients had higher incidence of PMI (aHR 1.4 [95%CI 1.1-1.7], P < 0.001). There was no significant difference in the incidence of MACE (aHR 1.3 [95%CI 0.9-1.7], P = 0.074).
In patients undergoing arterial vascular surgery, being operated in the afternoon/night was independently associated with increased all-cause mortality rates and incidence of perioperative myocardial injury/infarction.
关于非心脏手术后死亡率和心脏结局的日间变化，报告结果相互矛盾。在这项队列研究中，我们评估手术时间是否会影响接受非心脏动脉血管手术的患者的全因死亡率和心血管结局。
2012 年至 2018 年间，前瞻性纳入 1267 例接受非心脏动脉血管手术的患者，并将其分为两组：上午（7：00 至 12：00，79%）和下午/夜间（12：01 至次日 6：59，21%）手术。主要终点为 30 天和 1 年内的全因死亡率。次要终点为围手术期心肌损伤/梗死（PMI）的发生率和出院时主要不良心脏事件（MACE，包括急性心肌梗死、急性心力衰竭、心律失常、心血管死亡）的发生率。
多变量 Cox 比例风险回归调整混杂因素后，下午/夜间手术的 30 天和 1 年全因死亡率更高（校正后风险比 [aHR] 1.6 [95%置信区间 1.1-2.3]，P = 0.015 和 aHR 1.7 [95%CI 1.3-2.2]，P < 0.001）。下午/夜间组患者 PMI 发生率更高（aHR 1.4 [95%CI 1.1-1.7]，P < 0.001）。MACE 发生率无显著差异（aHR 1.3 [95%CI 0.9-1.7]，P = 0.074）。
在接受动脉血管手术的患者中，下午/夜间手术与全因死亡率升高和围手术期心肌损伤/梗死发生率增加独立相关。
