Background

There is a paucity of evidence surrounding the issue of delays on the day of surgery with respect to both causes and consequences. We sought to determine whether patients whose operations started late were at increased risk of post-operative complications.

Methods

We conducted a retrospective cohort study of 1420 first-of-the-day common general surgical procedures, dividing these into “on-time start” (OTS) and “late-start” (LS) cases. Our primary outcomes were minor and major complication rate; our secondary objective was to identify factors predicting LS. Groups were compared using univariable and multivariable analysis.

Results

LS rate was 55.3%. On univariable analysis, LS had higher rates of major and minor complications (7.3% vs. 3.5%, p = 0.002; 3.8% vs. 1.6%, p = 0.011). On multivariable analysis, LS was not associated with increased odds of any complications. Minor complications were predicted by operative duration [OR = 1.005 (1.002–1.008)], female sex [OR = 1.78 (1.037–3.061)], and undergoing an ileostomy closure procedure [OR = 10.60 (2.791–40.246)], and were reduced in those undergoing surgery on Wednesdays [OR = 0.38 (0.166–0.876)]. Major complications were predicted by operative duration [OR = 1.007 (1.003–1.011)] and ASA class [OR = 6.73 (1.505–30.109)]. Multivariable analysis using LS as an outcome identified that anesthesia time [OR = 1.35 (1.031–1.403)], insulin-dependent diabetes [OR = 1.91 (1.128–3.246)], and dyspnea upon moderate exertion [OR = 2.52 (1.423–4.522)] were predictive of LS.

Conclusions

Most cases in our study started late. While this has significant efficiency and economic costs, it is not associated with adverse patient outcomes. This topic remains incompletely described. Further research is needed to improve efficiency and patient experience by investigating the causes of operative delays.

中文翻译：

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晚开始不会增加接受普通普通外科手术的患者术后并发症的风险

背景

关于手术当天延误的原因和后果的证据很少。我们试图确定手术开始较晚的患者术后并发症的风险是否增加。

方法

我们对 1420 例日常普通外科手术进行了回顾性队列研究，将其分为“准时开始”(OTS) 和“延迟开始”(LS) 病例。我们的主要结果是轻微和主要并发症发生率；我们的次要目标是确定预测 LS 的因素。使用单变量和多变量分析比较各组。

结果

LS率为55.3%。在单变量分析中，LS 的主要和次要并发症发生率较高（7.3% 对 3.5%，p  = 0.002；3.8% 对 1.6%，p = 0.011）。在多变量分析中，LS 与任何并发症发生几率的增加无关。手术持续时间 [OR = 1.005 (1.002–1.008)]、女性 [OR = 1.78 (1.037–3.061)] 和接受回肠造口术闭合手术 [OR = 10.60 (2.791–40.246)] 可预测轻微并发症，并且在周三接受手术的患者中减少 [OR = 0.38 (0.166–0.876)]。主要并发症由手术持续时间 [OR = 1.007 (1.003–1.011)] 和 ASA 分级 [OR = 6.73 (1.505–30.109)] 预测。使用 LS 作为结果的多变量分析确定麻醉时间 [OR = 1.35 (1.031–1.403)]、胰岛素依赖型糖尿病 [OR = 1.91 (1.128–3.246)] 和适度运动时呼吸困难 [OR = 2.52 (1.423–4.522) )] 预测 LS。

结论

我们研究中的大多数病例起步较晚。虽然这具有显着的效率和经济成本，但它与患者的不良结果无关。该主题仍未完整描述。需要进一步研究，通过调查手术延误的原因来提高效率和患者体验。