Circadian aspects of post-operative morbidity and mortality

It has been well established that there exists a circadian concentration of cardiovascular, cerebrovascular and cardiopulmonary events. The aim was to describe aspects of circadian variation in relation to cardiovascular, cerebrovascular and thromboembolic diseases and to describe the literature concerning post-operative circadian disturbances. We also present the literature concerning circadian variation in post-operative morbidity and mortality. PubMed and the Cochrane database were searched for papers using a combination of 'circadian,''surgery,''post-operative,''mortality' and 'morbidity.' Eleven relevant studies were found, and seven of these were excluded due to the use of time of surgery and not time of morbidity or mortality as the main variable. The results from the four articles showed a circadian distribution of morbidity and mortality that mimics the one seen without surgery. There is a peak incidence of myocardial ischemia, fatal thromboembolism and sudden unexpected death in the morning hours. A circadian variation exists in post-operative morbidity and mortality. The observed circadian variation in post-operative morbidity and mortality may warrant a chronopharmacological approach to patients in the perioperative period. The underlying pathophysiological mechanisms should be the focus for future studies.