A recent prospective study reported a decrease in postoperative mortality when cardiac surgery was started in the afternoon instead of in the morning. In contrast, several large retrospective analyses have not confirmed this finding. Larger prospective studies are required to elucidate the effects of circadian rhythm on postoperative outcomes.
To identify any relation between starting time of anaesthesia/surgery and postoperative outcomes in patients aged 80 years or older to aid in clinical decision making with regard to scheduling surgery.
Patients aged 80 years or older having major elective or urgent intervention with anaesthesia starting time between 7 a.m. and 7 p.m.
We included 3551 patients of whom 2592 had an intervention starting in the morning (7 a.m. to 1 p.m.). These patients, compared with those with interventions in the afternoon (1 p.m. to 7 p.m.), were slightly younger, were less frail but had a longer duration of the intervention. Hospital length of stay or postoperative complications were not different between morning or afternoon interventions. Multivariable analysis showed no impact of time of anaesthesia (morning vs. afternoon) on hospital length of stay or postoperative complications, hazard ratio of 1.03 (95% CI 0.94 to 1.12) and odds ratio of 1.13 (95% CI 0.92 to 1.39), respectively.
Our results do not support the hypothesis of circadian effects on postoperative outcomes for elective and urgent major interventions in patients at least 80 years of age.
- This secondary analysis of the POSE study, with patients aged at least 80 years undergoing major elective or urgent interventions, showed no evidence for circadian effects on postoperative outcomes.
- Increased age, duration of anaesthesia, urgency, ASA physical status, frailty, multimorbidity and in-patient status variables were independently associated with hospital LOS and postoperative complications.
- Median (95% CI) hospital length of stay for interventions in the morning and the afternoon was 7 (6 to 7) and 6 (6 to 6) days, P = 0.39, respectively.