Key result
Afternoon and night arterial vascular surgeries linked to ~60% higher 30-day mortality.
Why the study?
Conflicting results have been reported regarding the impact of daytime variation on mortality and cardiac outcomes following non-cardiac surgeries.
Does performing arterial vascular surgery in the afternoon/night increase all-cause mortality and cardiovascular complications compared to morning surgery?
Cohort (n=1,267)
Does performing arterial vascular surgery in the afternoon/night increase all-cause mortality and cardiovascular complications compared to morning surgery?
Performing arterial vascular surgeries in the afternoon or night is independently associated with increased 30-day and 1-year all-cause mortality and perioperative myocardial injury compared to morning surgeries.
May support morning scheduling of arterial vascular surgery when feasible; hypothesis-generating and requires prospective trials before practice change.
BACKGROUND: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.
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Artioli et al. (2023) conducted a cohort in non-cardiac arterial vascular surgeries (n=1,267). Afternoon/night surgeries vs. Morning surgeries was evaluated on all-cause mortality within 30 days and one year (aHR 1.6 (30 days), aHR 1.7 (1 year), 95% CI 1.1-2.3 (30 days), 1.3-2.2 (1 year), p=0.015 (30 days), <0.001 (1 year)). Arterial vascular surgeries performed in the afternoon/night were associated with increased all-cause mortality at 30 days (aHR 1.6; 95% CI 1.1-2.3) and 1 year (aHR 1.7; 95% CI 1.3-2.2).
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