Complications of Daytime Elective Laparoscopic Cholecystectomies Performed by Surgeons Who Operated the Night Before
Complications of Daytime Elective Laparoscopic Cholecystectomies Performed by Surgeons Who Operated the Night Before
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DOI：
10.1001/jama.2013.280372
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发表时间：
2013-11-06
影响因子：
120.7
通讯作者：
Garg, Amit X.
中科院分区：
文献类型：
--
作者：
Vinden, Christopher;Nash, Danielle M.;Garg, Amit X.
重要性外科医生的睡眠中断对病人的outcomes.Objective的影响，以评估如果外科医生操作的前一天晚上有更多的并发症的择期手术进行了第二天DESIGN，设置，和参与者人口为基础的，匹配的，回顾性队列研究，使用行政卫生保健数据库在安大略，加拿大（2012年人口，13 505 900）。参与者包括2078名接受择期腹腔镜胆囊切除术的患者，这些患者由前一天晚上手术的外科医生进行，与其他4名择期腹腔镜胆囊切除术接受者相匹配（n = 8312）。暴露2004年至2011年间，总共进行了94183例符合条件的择期腹腔镜胆囊切除术。在这些手术中，有2078例手术，其中102家社区医院的331名不同的外科医生在午夜至前一天早上7点之间进行了手术。每个“风险”手术随机匹配4个其他选择性腹腔镜胆囊切除术（n = 8312）由同一外科医生，谁没有证据的前一天晚上操作。主要结局和措施的主要结果是从腹腔镜胆囊切除术开放胆囊切除术的转换。次要结局包括医源性损伤或死亡的证据。结果：前一晚手术的外科医生与前一晚未手术的外科医生相比，中转开腹率无显著相关性（46/2031 [2.2%] vs 157/8124 [1.9%];校正比值比[OR]，1.18; 95%CI，0.85-1.64）。前一天晚上手术与前一天晚上不手术之间没有关联，医源性损伤风险（14/2031 [0.7%] vs 72/8124 [0.9%];调整后OR，0.77; 95%CI，0.43-1.37）或死亡（
IMPORTANCE The effect of surgeons' disrupted sleep on patient outcomes is not clearly defined.OBJECTIVE To assess if surgeons operating the night before have more complications of elective surgery performed the next day.DESIGN, SETTING, AND PARTICIPANTS Population-based, matched, retrospective cohort study using administrative health care databases in Ontario, Canada (2012 population, 13 505 900). Participants were 2078 patients who underwent elective laparoscopic cholecystectomies performed by surgeons who operated the night before, matched with 4 other elective laparoscopic cholecystectomy recipients (n = 8312).EXPOSURE In total, 94 183 eligible elective laparoscopic cholecystectomies were performed between 2004 and 2011. Of these surgeries, there were 2078 procedures in which 331 different surgeons across 102 community hospitals had operated between midnight and 7 AM the night before. Each "at-risk" surgery was randomly matched with 4 other elective laparoscopic cholecystectomies (n = 8312) performed by the same surgeon, who had no evidence of having operated the night before.MAIN OUTCOMES AND MEASURES The primary outcome was conversion from a laparoscopic cholecystectomy to open cholecystectomy. Secondary outcomes included evidence of iatrogenic injuries or death. Risks were quantified using generalized estimating equations.RESULTS No significant association was found in conversion rates to open operations between surgeons when they operated the night before compared with when they did not operate the previous night (46/2031 [2.2%] vs 157/8124 [1.9%]; adjusted odds ratio [OR], 1.18; 95% CI, 0.85-1.64). There was no association between operating the night before vs not operating the night before, and risk of iatrogenic injuries (14/2031 [0.7%] vs 72/8124 [0.9%]; adjusted OR, 0.77; 95% CI, 0.43-1.37) or death (