Outcomes of Daytime Procedures Performed by Attending Surgeons after Night Work
Outcomes of Daytime Procedures Performed by Attending Surgeons after Night Work
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DOI：
10.1056/nejmsa1415994
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发表时间：
2015-08-27
影响因子：
158.5
通讯作者：
Baxter, Nancy N.
中科院分区：
文献类型：
--
作者：
Govindarajan, Anand;Urbach, David R.;Baxter, Nancy N.
背景主治医生睡眠不足对患者预后的影响尚不清楚。在这项研究中，我们考察了午夜后医生提供的医疗服务对他们白天进行的定期选择性手术结果的影响。方法：我们在加拿大安大略省进行了一项基于人群的、回顾性的匹配队列研究。接受12项日间选择性手术中的1项的患者，由曾在午夜至早上7点治疗过患者的医生进行。以1：1的比例与同一医生在午夜后没有治疗患者的一天接受相同程序的患者进行匹配。结果包括死亡、再入院、并发症、住院时间和手术持续时间。我们使用广义估计方程来比较患者组之间的结果。结果在这项研究中，我们包括了38,978名患者，由1448名医生治疗，其中40.6%在学术中心接受治疗。我们发现，由午夜后提供病人护理的医生进行日间手术的患者与午夜后没有治疗患者的医生进行的手术在主要结果(死亡、再入院或并发症)方面没有显著差异(分别为22.2%和22.4%；P=0.66；调整后的优势比为0.99；95%可信区间为0.95至1.03)。我们还发现，在对学术中心和非学术中心、医生的年龄或手术类型进行分层后，结果没有显著差异。二次分析显示，两组患者在住院时间或手术持续时间上没有显著差异。结论总的来说，无论医生是否在前一天晚上提供医疗服务，选择性日间手术不良结果的风险都是相似的。
BACKGROUNDSleep loss in attending physicians has an unclear effect on patient outcomes. In this study, we examined the effect of medical care provided by physicians after midnight on the outcomes of their scheduled elective procedures performed during the day.METHODSWe conducted a population-based, retrospective, matched-cohort study in Ontario, Canada. Patients undergoing 1 of 12 elective daytime procedures performed by a physician who had treated patients from midnight to 7 a.m. were matched in a 1: 1 ratio to patients undergoing the same procedure by the same physician on a day when the physician had not treated patients after midnight. Outcomes included death, readmission, complications, length of stay, and procedure duration. We used generalized estimating equations to compare outcomes between patient groups.RESULTSWe included 38,978 patients, treated by 1448 physicians, in the study, of whom 40.6% were treated at an academic center. We found no significant difference in the primary outcome (death, readmission, or complication) between patients who underwent a daytime procedure performed by a physician who had provided patient care after midnight and those who underwent a procedure performed by a physician who had not treated patients after midnight (22.2% and 22.4%, respectively; P = 0.66; adjusted odds ratio, 0.99; 95% confidence interval, 0.95 to 1.03). We also found no significant difference in outcomes after stratification for academic versus nonacademic center, physician's age, or type of procedure. Secondary analyses revealed no significant difference between patient groups in length of stay or procedure duration.CONCLUSIONSOverall, the risks of adverse outcomes of elective daytime procedures were similar whether or not the physician had provided medical services the previous night.