Key result
Afternoon non-cardiac surgery showed no difference in perioperative myocardial injury compared to morning surgery (16.4% vs 15.8%; p=0.94), but was associated with increased 1-year AMI risk.
Why the study?
Daytime variation in perioperative myocardial injury was recently observed in cardiac surgery, but whether it also occurs in non-cardiac surgery was unknown.
Does morning versus afternoon non-cardiac surgery affect the incidence of perioperative myocardial injury and subsequent cardiovascular events in patients at increased cardiovascular risk?
Cohort (n=1,641)
Does morning versus afternoon non-cardiac surgery affect the incidence of perioperative myocardial injury and subsequent cardiovascular events in patients at increased cardiovascular risk?
Absolute Event Rate: 16.4% vs 15.8%
p-value: p=0.94
Afternoon non-cardiac surgery is associated with an increased risk of acute myocardial infarction at 1 year compared to morning surgery, despite no difference in immediate perioperative myocardial injury.
Should not yet alter surgical scheduling; leaves open whether afternoon timing increases 1-year AMI risk in high-risk patients.
OBJECTIVE: Recently, daytime variation in perioperative myocardial injury (PMI) has been observed in patients undergoing cardiac surgery. We aim at investigating whether daytime variation also occurs in patients undergoing non-cardiac surgery. METHODS: In a prospective diagnostic study, we evaluated the presence of daytime variation in PMI in patients at increased cardiovascular risk undergoing non-cardiac surgery, as well as its possible impact on the incidence of acute myocardial infarction (AMI), and death during 1-year follow-up in a propensity score-matched cohort. PMI was defined as an absolute increase in high-sensitivity cardiac troponin T (hs-cTnT) concentration of ≥14 ng/L from preoperative to postoperative measurements. RESULTS: Of 1641 patients, propensity score matching defined 630 with similar baseline characteristics, half undergoing non-cardiac surgery in the morning (starting from 8:00 to 11:00) and half in the afternoon (starting from 14:00 to 17:00). There was no difference in PMI incidence between both groups (morning: 50, 15.8% (95% CI 12.3 to 20.3); afternoon: 52, 16.4% (95% CI 12.7 to 20.9), p=0.94), nor if analysing hs-cTnT release as a quantitative variable (median morning group: 3 ng/L (95% CI 1 to 7 ng/L); median afternoon group: 2 ng/L (95% CI 0 to 7 ng/L; p=0.16). During 1-year follow-up, the incidence of AMI was 1.2% (95% CI 0.4% to 3.2%) among morning surgeries versus 4.1% (95% CI 2.3% to 6.9%) among the afternoon surgeries (corrected HR for afternoon surgery 3.44, bootstrapped 95% CI 1.33 to 10.49, p log-rank=0.03), whereas no difference in mortality emerged (p=0.70). CONCLUSIONS: Although there is no daytime variation in PMI in patients undergoing non-cardiac surgery, the incidence of AMI during follow-up is increased in afternoon surgeries and requires further study. CLINICAL TRIAL REGISTRATION: NCT02573532;Results.
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Lavallaz et al. (2018) conducted a cohort in Non-cardiac surgery at increased cardiovascular risk (n=1,641). Afternoon surgery (14:00 to 17:00) vs. Morning surgery (8:00 to 11:00) was evaluated on Perioperative myocardial injury (PMI) (p=0.94). Afternoon non-cardiac surgery showed no difference in perioperative myocardial injury compared to morning surgery (16.4% vs 15.8%; p=0.94), but was associated with increased 1-year AMI risk.
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