Key result
Starting anaesthesia in the morning compared to the afternoon did not significantly affect hospital length of stay (HR 1.03) in patients aged 80 years or older undergoing major interventions.
Why the study?
Conflicting findings exist regarding whether surgery start time influences postoperative outcomes, prompting prospective evaluation of circadian effects in patients aged 80 years or older.
Does anaesthesia starting in the morning compared to the afternoon reduce hospital length of stay and postoperative complications in patients aged 80 years or older undergoing major interventions?
Observational (n=3,551)
Yes
Does anaesthesia starting in the morning compared to the afternoon reduce hospital length of stay and postoperative complications in patients aged 80 years or older undergoing major interventions?
Hazard Ratio: 1.03 (95% CI 0.94–1.12)
Absolute Event Rate: 7% vs 6%
p-value: p=0.51
In patients aged 80 years or older undergoing major elective or urgent interventions, the starting time of anaesthesia (morning vs. afternoon) does not significantly impact hospital length of stay or postoperative complications.
Starting time of anaesthesia was unrelated to outcomes in patients ≥80 years; leaves open whether circadian timing affects perioperative risk in the elderly.
BACKGROUND: A recent prospective study reported a decrease in postoperative mortality when cardiac surgery was started in the afternoon instead of in the morning. In contrast, several large retrospective analyses have not confirmed this finding. Larger prospective studies are required to elucidate the effects of circadian rhythm on postoperative outcomes. OBJECTIVE: To identify any relation between starting time of anaesthesia/surgery and postoperative outcomes in patients aged 80 years or older to aid in clinical decision making with regard to scheduling surgery. DESIGN: A multivariable model with a priori defined confounders was constructed to evaluate the impact of anaesthesia starting time on hospital length of stay and postoperative complications. SETTING: A European multicentre, observational study of outcomes after geriatric anaesthesia from October 2017 to December 2018. PATIENTS: Patients aged 80 years or older having major elective or urgent intervention with anaesthesia starting time between 7 a.m. and 7 p.m. MAIN OUTCOME MEASURE: Primary outcome measure was the difference in hospital length of stay after any major elective or urgent morning or afternoon intervention. RESULTS: We included 3551 patients of whom 2592 had an intervention starting in the morning (7 a.m. to 1 p.m.). These patients, compared with those with interventions in the afternoon (1 p.m. to 7 p.m.), were slightly younger, were less frail but had a longer duration of the intervention. Hospital length of stay or postoperative complications were not different between morning or afternoon interventions. Multivariable analysis showed no impact of time of anaesthesia (morning vs. afternoon) on hospital length of stay or postoperative complications, hazard ratio of 1.03 (95% CI 0.94 to 1.12) and odds ratio of 1.13 (95% CI 0.92 to 1.39), respectively. CONCLUSION: Our results do not support the hypothesis of circadian effects on postoperative outcomes for elective and urgent major interventions in patients at least 80 years of age. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03152734.
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Hoogma et al. (2022) conducted an observational in Major elective or urgent intervention in older adults (n=3,551). Anaesthesia starting time in the morning (7 a.m. to 1 p.m.) vs. Anaesthesia starting time in the afternoon (1 p.m. to 7 p.m.) was evaluated on Hospital length of stay (HR 1.03, 95% CI 0.94 to 1.12, p=0.51). Starting anaesthesia in the morning compared to the afternoon did not significantly affect hospital length of stay (HR 1.03) in patients aged 80 years or older undergoing major interventions.
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