Surgical time, peri-operative major adverse cardiac and cerebral events and hospital stay in noncardiac surgery: insights from 7-day service implementation

Posted on by Dr Clemens

AUTHORS: Weixian Xu et al 

European Journal of Anaesthesiology August 06, 2026.
BACKGROUND
The ‘out of hours effect’ applies to patients undergoing surgery during night shifts, weekends or holidays, who face higher risks of complications and mortality. The 7-day service policy was implemented to ensure consistent healthcare delivery.

OBJECTIVE

To assess the association between surgical time and incidence of major peri-operative adverse cardiac and cerebral events (MACCE) and also the length of hospital stay, and whether this has changed following the implementation of the 7-day service.

RESULTS

Night-shift procedures were associated with higher incidence of peri-operative MACCE (28.7 vs. 18.2%, P < 0.001), longer hospital stays (172 vs. 155 h, P < 0.01), and higher costs (48 529 vs. 37 962 yuan, P < 0.001). In multivariable logistic regression, night-shift surgery remained independently associated with MACCE [fully adjusted odds ratio (OR) 1.54, 95% confidence interval (CI), 1.3 to 1.8; P < 0.001]. Weekend surgery was not significantly associated with MACCE after full adjustment (OR 1.15, 95% CI, 0.96 to 1.38; P = 0.13), and results were consistent in a sensitivity model including both night-shift and weekend surgery (night shift OR 1.54, 95% CI, 1.3 to 1.82, P < 0.001; weekend OR 1.17, 95% CI, 0.97 to 1.4, P = 0.09). Following implementation of the 7-day service policy, night-shift procedures decreased [16.1% prepolicy vs. 3.7% postpolicy; standardised mean difference (SMD) 0.42] and weekend procedures increased (5.5 vs. 13.3%; SMD 0.27). In the postpolicy period, weekend surgery was associated with a shorter hospital stay (139 vs. 160 h, P < 0.001) without an increase in MACCE (18.7 vs. 19.4%, P = 0.53).

CONCLUSION

KEY POINTS

  • Night-shift surgery is an independent risk factor for major adverse peri-operative cardiac and cerebral events after noncardiac surgery.
  • The 7-day service policy reduced night-shift procedures and increased those at weekends, without increasing major adverse cardiac and cerebral events.
  • Weekend procedures were associated with significantly shorter hospital stays, suggesting a benefit of the 7-day service policy.

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