The importance of being the morning case in adult cardiac surgery: a propensity-matched analysis

被引:1
作者
Ranucci, Marco [1 ,5 ]
Casalino, Stefano [1 ]
Frigiola, Alessandro [2 ]
Diena, Marco [2 ]
Parolari, Alessandro [3 ]
Boveri, Sara [4 ]
Menicanti, Lorenzo [2 ]
De Vincentiis, Carlo [2 ]
机构
[1] IRCCS Policlin San Donato, Dept Cardiovasc Anesthesia & Intens Care, Milan, Italy
[2] IRCCS Policlin San Donato, Dept Adult Cardiac Surg, Milan, Italy
[3] Dept Univ Cardiac Surg & Translat Res, IRCCS Policlin San Donato, Milan, Italy
[4] IRCCS Policlin San Donato, Lab Biostat & Data Management, Sci Directorate, Milan, Italy
[5] IRCCS Policlin San Donato, Dept Cardiovasc Anesthesia & Intens Care, Piazza Malan 2, I-20097 Milan, Italy
关键词
Morbidity; Mortality; Outcome; Daytime variation; Cardiac surgery; DAYTIME VARIATION; MORTALITY; ASSOCIATION; OUTCOMES; TIME;
D O I
10.1093/ejcts/ezad089
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
OBJECTIVES: The quality of the outcome after cardiac surgery with cardiopulmonary bypass depends on the patient demographics, co-morbidities, complexity of the surgical procedure and expertise of surgeons and the whole staff. The purpose of the present study is to analyse the timing of surgery (morning versus afternoon) with respect to morbidity and mortality in adult cardiac surgery.METHODS: The primary end point was the incidence of major morbidity defined according to a modified Society of Thoracic Surgeon criterion. We consecutively included all the adult (>18 years) patients receiving a cardiac surgery operation at our Institution.RESULTS: From 2017 through 2019, a total of 4003 cardiac surgery patients were operated. With a propensity-matching technique a final patient population of 1600 patients was selected, with 800 patients in the first-case surgery group and 800 in the second-case surgery group. Patients in the second-case group had a major morbidity rate of 13% vs 8.8% in the first-case group (P = 0.006), and a higher rate of 30-day mortality (4.1% vs 2.3%, P = 0.033). After correction for EuroSCORE and operating surgeon, the second-case group confirmed a higher rate of major morbidity (odds ratio 1.610, 95% confidence interval 1.16-2.23, P = 0.004).CONCLUSION: Our study suggests that patients operated as second cases are exposed to an increased morbidity and mortality probably due to fatigue, loss of attention and hurriedness in the operating room and decreased human resources in the intensive care unit.
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页数:9
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共 30 条
[1]   Starting elective cardiac surgery after 3 PM does not impact patient morbidity, mortality, or hospital costs [J].
Axtell, Andrea L. ;
Moonsamy, Philicia ;
Melnitchouk, Serguei ;
Jassar, Arminder S. ;
Villavicencio, Mauricio A. ;
D'Alessandro, David A. ;
Tolis, George ;
Cameron, Duke ;
Sundt, Thoralf M. .
JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, 2020, 159 (06) :2314-+
[2]   Effect of operative time on the outcome of patients undergoing off-pump coronary artery bypass surgery [J].
Baik, Jaewon ;
Nam, Jae-Sik ;
Oh, Jimi ;
Kim, Go Wun ;
Lee, Eun-Ho ;
Lee, Yoon-Kyung ;
Chung, Cheol Hyun ;
Choi, In-Cheol .
JOURNAL OF CARDIAC SURGERY, 2019, 34 (11) :1220-1227
[3]  
Bailey D, 2021, Cureus, V13
[4]   Cardiac surgery in the afternoon is not associated with increased operative morbidity and mortality [J].
Bianco, Valentino ;
Aranda-Michel, Edgar ;
Serna-Gallegos, Derek ;
Kilic, Arman ;
Kaczarowski, David J. ;
Dunn-Lewis, Courtenay ;
Thoma, Floyd ;
Navid, Forozan ;
Sultan, Ibrahim .
JOURNAL OF CARDIAC SURGERY, 2021, 36 (10) :3599-3606
[5]   STS Adult Cardiac Surgery Database: 2021 Update on Outcomes, Quality, and Research [J].
Bowdish, Michael E. ;
D'Agostino, Richard S. ;
Thourani, Vinod H. ;
Schwann, Thomas A. ;
Krohn, Carole ;
Desai, Nimesh ;
Shahian, David M. ;
Fernandez, Felix G. ;
Badhwar, Vinay .
ANNALS OF THORACIC SURGERY, 2021, 111 (06) :1770-1780
[6]   Variation of mortality after coronary artery bypass surgery in relation to hour, day and month of the procedure [J].
Coumbe, Ann ;
John, Ranjit ;
Kuskowski, Michael ;
Agirbasli, Mehmet ;
McFalls, Edward O. ;
Adabag, Selcuk .
BMC CARDIOVASCULAR DISORDERS, 2011, 11
[7]   Is Nocturnal Extubation After Cardiac Surgery Associated With Worse Outcomes? [J].
Diwan, Murtaza ;
Wolverton, Jeremy ;
Yang, Bo ;
Haft, Jonathan ;
Geltz, Amy ;
Loik, Paul ;
Engoren, Milo .
ANNALS OF THORACIC SURGERY, 2019, 107 (01) :41-46
[8]   Daytime and outcomes after cardiac surgery: Systematic review and metaanalysis, insights from a large UK database review and post-hoc trial analysis [J].
Fudulu, Daniel Paul ;
Dimagli, Arnaldo ;
Dixon, Lauren ;
Sandhu, Manraj ;
Cocomello, Lucia ;
Angelini, Gianni D. ;
Benedetto, Umberto .
LANCET REGIONAL HEALTH-EUROPE, 2021, 7
[9]   Patient safety: Fatigue among clinicians and the safety of patients [J].
Gaba, DM ;
Howard, SK .
NEW ENGLAND JOURNAL OF MEDICINE, 2002, 347 (16) :1249-1255
[10]   Association Between Overnight Extubations and Outcomes in the Intensive Care Unit [J].
Gershengorn, Hayley B. ;
Scales, Damon C. ;
Kramer, Andrew ;
Wunsch, Hannah .
JAMA INTERNAL MEDICINE, 2016, 176 (11) :1651-1660