Operative Start Times and Complications After Liver Transplantation
Operative Start Times and Complications After Liver Transplantation
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DOI：
10.1111/j.1600-6143.2010.03177.x
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发表时间：
2010-08-01
影响因子：
8.8
通讯作者：
Ortiz, J. A.
中科院分区：
文献类型：
--
作者：
Lonze, B. E.;Parsikia, A.;Ortiz, J. A.
最近国家对病人安全的关注导致了对夜间手术的风险和益处的重新审视。在肝移植中，夜间手术的假设风险必须与延长冷缺血的公认风险或操纵手术开始时间的策略的潜在风险进行权衡。对1995年至2008年期间在一家机构进行的578例肝移植进行了回顾性分析，以确定术后并发症的发生率是否与手术开始时间相关。我们假设并发症发生率和手术开始时间之间没有相关性。当比较8个3小时时间分层时，未观察到术后伤口、血管、胆道或其他并发症的相对风险的一致趋势。当两个12小时的时间层（晚上，下午3点-凌晨3时，上午3时-下午3时）结果显示，两组的并发症无显著差异，但夜间手术持续时间较长，与日间手术相比，夜间手术的早期死亡风险高两倍（调整后OR 2.9，95%CI 1.16-7.00，p = 0.023），尽管两个亚组的长期生存率无显著差异。这一意见值得进一步评价，并强调需要探讨和确定各机构的具体做法，以确保一天中任何时候都能安全运作。
The recent national focus on patient safety has led to a re-examination of the risks and benefits of nighttime surgery. In liver transplantation, the hypothetical risks of nighttime operation must be weighed against either the well-established risks of prolonging cold ischemia or the potential risks of strategies to manipulate operative start times. A retrospective review was conducted of 578 liver transplants performed at a single institution between 1995 and 2008 to determine whether the incidence of postoperative complications correlated with operative start times. We hypothesized that no correlation would be observed between complication rates and operative start times. No consistent trends in relative risk of postoperative wound, vascular, biliary, or other complications were observed when eight 3-h time strata were compared. When two 12-h time strata (night, 3 p.m.-3 a.m., and day, 3 a.m.-3 p.m.) were compared, complications were not significantly different, but nighttime operations were longer in duration, and were associated a twofold greater risk of early death compared to daytime operations (adjusted OR 2.9, 95% CI 1.16-7.00, p = 0.023), though long-term survival did not differ significantly between the subgroups. This observation warrants further evaluation and underscores the need to explore and identify institution-specific practices that ensure safe operations regardless of time of day.