Zhao Yi, Chen Na-Ping, Su Xian, Ma Jia-Hui, Wang Dong-Xin
Department of Anesthesiology, Peking University First Hospital, Beijing, 100034, China.
Outcomes Research Consortium, Houston, TX, USA.
BMC Anesthesiol. 2024 Dec 19;24(1):465. doi: 10.1186/s12871-024-02825-x.
Overtime work is common in anesthesiologists due to shortage of manpower. Herein, we analyzed if overtime work of anesthesiologists was associated with delirium development in older patients after surgery.
This was a secondary analysis of the database from a randomized trial. Seven hundred older patients (aged ≥ 65 years) who were admitted to the intensive care unit (ICU) after elective noncardiac surgery were enrolled in the underlying trial. Anesthesiologists who worked continuously for more than 8 h by the end of the surgery were marked as "work overtime". Delirium was assessed with the Confusion Assessment Method for the ICU twice daily during the first 7 postoperative days. The association between overtime work of anesthesiologists and development of postoperative delirium was analyzed with multivariable logistic regression models.
All 700 patients (mean age 74.3 years, 39.6% female) were included in this analysis. Anesthesiologists of 281 patients (40.1%) were marked as "work overtime" at the end of surgery. When compared with patients whose anesthesiologists didn't work overtime, patients whose anesthesiologist worked overtime had a higher incidence of delirium within 7 days (20.3% [57/281] vs. 12.9% [54/419], P = 0.009). After correction for confounding factors, both overtime work (OR 1.87, 95% CI 1.19-2.94, P = 0.007) and prolonged continuous working hours of anesthesiologists (OR 1.08, 95% CI 1.01-1.15, P = 0.020) were associated with an increased risk of postoperative delirium.
Overtime work of anesthesiologists was associated with an increased risk of delirium development in older patients admitted to ICU after major noncardiac surgery.
The underlying trial was registered with Chinese Clinical Trial Registry ( https://www.chictr.org.cn/showproj.html?proj=8734 ; ChiCTR-TRC-10000802; March 18, 2010).
由于人力短缺，麻醉医生加班工作很常见。在此，我们分析了麻醉医生的加班工作是否与老年患者术后谵妄的发生有关。
这是一项对随机试验数据库的二次分析。纳入了700例择期非心脏手术后入住重症监护病房（ICU）的老年患者（年龄≥65岁）作为基础试验对象。手术结束时连续工作超过8小时的麻醉医生被标记为“加班”。术后前7天每天两次使用ICU意识模糊评估方法评估谵妄。采用多变量逻辑回归模型分析麻醉医生加班工作与术后谵妄发生之间的关联。
所有700例患者（平均年龄74.3岁，女性占39.6%）均纳入本分析。281例患者（40.1%）的麻醉医生在手术结束时被标记为“加班”。与麻醉医生未加班的患者相比，麻醉医生加班的患者在7天内谵妄发生率更高（20.3%[57/281]对12.9%[54/419]，P = 0.009）。校正混杂因素后，加班工作（比值比1.87，95%置信区间1.19 - 2.94，P = 0.007）和麻醉医生延长的连续工作时间（比值比1.08，95%置信区间1.01 - 1.15，P = 0.020）均与术后谵妄风险增加相关。
麻醉医生的加班工作与大型非心脏手术后入住ICU的老年患者谵妄发生风险增加有关。
基础试验已在中国临床试验注册中心注册（https://www.chictr.org.cn/showproj.html?proj=8734；ChiCTR - TRC - 10000802；2010年3月18日）。
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