Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Department of Anesthesiology, Lu'an Hospital Affiliated to Anhui Medical University, Lu'an People's Hospital, Lu'an, China.
Ann Med. 2023 Dec;55(1):1134-1143. doi: 10.1080/07853890.2023.2187875.
Circadian rhythm involved with physiology has been reported to affect pharmacokinetics or pharmacodynamics. We hypothesized that circadian variations in physiology disturb anesthesia and eventually affect recovery after anesthesia.
A retrospective cohort study initially included 107,406 patients (1 June 2016-6 June 2021). Patients were classified into morning or afternoon surgery groups. The primary outcome was daytime variation in PACU (post-anesthesia care unit) recovery time and Steward score. Inverse probability weighting (IPW) approach based on propensity score and univariable/multivariable linear regression were used to estimate this outcome.
Of 28,074 patients, 13,418 (48%) patients underwent morning surgeries, and 14,656 (52%) patients underwent afternoon surgeries. LOWESS curves and IPW illustrated daytime variation in PACU recovery time and Steward score. Before adjustment, compared to morning surgery group, afternoon surgery group had less PACU recovery time (median [interquartile range], 57 [46, 70] 54 [43, 66], < 0.001) and a higher Steward score (5.62 [5.61, 5.63] 5.66 [5.65, 5.67], < 0.001). After adjustment, compared to morning surgery group, afternoon surgery group had less PACU recovery time (58 [46, 70] 54 [43, 66], < 0.001). In multivariable linear regression, morning surgery is statistically associated with an increased PACU recovery time (coefficient, -3.20; 95% confidence interval, -3.55 to -2.86).
Among non-cardiac surgeries, daytime variation might affect recovery after general anesthesia. These findings indicate that the timing of surgery improves recovery after general anesthesia, with afternoon surgery providing protection.KEY MESSAGESIn this retrospective cohort study of 28,074 participants, the afternoon surgery group has a higher Steward score than the morning surgery group.In multivariable linear regression, morning surgery is statistically associated with an increased PACU recovery time.Among non-cardiac surgeries, daytime variation affects the recovery after general anesthesia, with afternoon surgery providing protection.
与生理相关的昼夜节律已被报道会影响药代动力学或药效动力学。我们假设生理昼夜节律的变化会干扰麻醉，并最终影响麻醉后的恢复。
一项回顾性队列研究最初纳入了 107406 名患者（2016 年 6 月 1 日至 2021 年 6 月 6 日）。患者被分为上午或下午手术组。主要结局是 PACU（麻醉后护理单元）恢复时间和 Steward 评分的日间变化。采用倾向评分和单变量/多变量线性回归的逆概率加权（IPW）方法来估计该结局。
在 28074 名患者中，13418 名（48%）患者接受了上午手术，14656 名（52%）患者接受了下午手术。LOWESS 曲线和 IPW 显示了 PACU 恢复时间和 Steward 评分的日间变化。在调整前，与上午手术组相比，下午手术组 PACU 恢复时间更短（中位数[四分位距]，57[46，70] vs. 54[43，66]，<0.001），Steward 评分更高（5.62[5.61，5.63] vs. 5.66[5.65，5.67]，<0.001）。调整后，与上午手术组相比，下午手术组 PACU 恢复时间更短（58[46，70] vs. 54[43，66]，<0.001）。在多变量线性回归中，上午手术与 PACU 恢复时间延长相关（系数，-3.20；95%置信区间，-3.55 至-2.86）。
在非心脏手术中，日间变化可能会影响全身麻醉后的恢复。这些发现表明手术时间的选择可以改善全身麻醉后的恢复，下午手术提供保护。
在这项纳入 28074 名参与者的回顾性队列研究中，下午手术组的 Steward 评分高于上午手术组。
多变量线性回归中，上午手术与 PACU 恢复时间延长相关。
在非心脏手术中，日间变化会影响全身麻醉后的恢复，下午手术提供保护。
