Background

Seasonal trends in patient outcomes are an under-researched area in perioperative care. This systematic review evaluates the published literature on seasonal variation in surgical outcomes worldwide.

Methods

MEDLINE, Embase, Cochrane, CINHAL, and Web of Science were searched for studies on major surgical procedures, examining mortality or other patient-relevant outcomes, across seasonal periods up to February 2019. Major surgery was defined as a procedure requiring an overnight stay in an inpatient medical facility. We included studies exploring variation according to calendar and meteorological seasons and recurring annual events including staff turnover. Quality was assessed using an adapted Downs and Black scoring system.

Results

The literature search identified 82 studies, including 22 210 299 patients from four continents. Because of the heterogeneity of reported outcomes and literature scope, a narrative synthesis was undertaken. Mass staff changeover was investigated in 37 studies; the majority (22) of these did not show strong evidence of worse outcomes. Of the 47 studies that examined outcomes across meteorological or calendar seasons, 33 found evidence of seasonal variation. Outcomes were often worse in winter (16 studies). This trend was particularly prominent amongst surgical procedures classed as an ‘emergency’ (five of nine studies). There was evidence for increased postoperative surgical site infections during summer (seven of 12 studies examining this concept).

Conclusion

This systematic review provides tentative evidence for an increased risk of postoperative surgical site infections in summer, and an increased risk of worse outcomes after emergency surgery in winter and during staff changeover times.

Clinical trial registration

PROSPERO CRD42019137214.

中文翻译：

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手术结果数据的季节性：系统评价和叙述性综合

背景

患者结局的季节性趋势是围手术期护理中研究不足的领域。本系统评价评估了已发表的关于全球手术结果季节性变化的文献。

方法

MEDLINE、Embase、Cochrane、CINHAL 和 Web of Science 搜索了截至 2019 年 2 月的季节性期间关于主要外科手术、检查死亡率或其他患者相关结果的研究。大手术被定义为需要在医院过夜的手术。住院医疗机构。我们纳入了根据日历和气象季节探索变化的研究，以及包括员工流动在内的经常性年度事件。使用改编的 Downs 和 Black 评分系统评估质量。

结果

文献检索确定了 82 项研究，包括来自四大洲的 22 210 299 名患者。由于报告结果和文献范围的异质性，进行了叙述性综合。在 37 项研究中调查了大规模人员转换；其中大多数 (22) 没有显示出更差结果的有力证据。在检查跨气象或日历季节的结果的 47 项研究中，33 项发现了季节性变化的证据。冬季的结果通常更糟（16 项研究）。这种趋势在被归类为“紧急”的外科手术中尤为突出（九项研究中的五项）。有证据表明夏季术后手术部位感染增加（检查这一概念的 12 项研究中有 7 项）。

结论

该系统评价提供了初步证据，证明夏季术后手术部位感染的风险增加，冬季急诊手术后和工作人员换班期间出现不良结果的风险增加。

临床试验注册

PROSPERO CRD42019137214。