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Published on: March 27, 2018
Nocturnal elective coronary artery bypass grafting (CABG) surgery is not associated with increased one-year mortality
Andreas Koköfer1, Christian Dinges2, Crispiana Cozowicz3
1Department of Anaesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria. a.kokoefer@gmail.com.
Insights
Nighttime elective coronary artery bypass grafting (CABG) surgery does not increase long-term or one-year mortality risk. This study found no significant difference in survival rates between daytime and nighttime CABG procedures.
Area of Science:
- Cardiology
- Cardiac Surgery
- Health Services Research
Background:
- Elective coronary artery bypass grafting (CABG) is increasingly performed during nighttime hours.
- Potential challenges include reduced staffing, circadian rhythm disruption, and fatigue, impacting surgical outcomes.
- Evidence on the impact of surgery timing on cardiac surgery outcomes remains inconclusive.
Purpose of the Study:
- To investigate the association between surgery timing (daytime vs. nighttime) and long-term survival in patients undergoing elective CABG.
- To assess the impact of nocturnal elective CABG on one-year mortality rates.
Main Methods:
- Retrospective cohort study of 723 elective CABG surgeries at a single institution (2017-2021).
- Comparison of long-term survival using Cox proportional hazard modeling.
- Evaluation of 30-day and one-year mortality using multiple linear regression analysis.
Main Results:
- No significant association was found between nighttime elective CABG and increased long-term mortality (aHR: 1.624, p=0.3179).
- Nighttime surgeries were not significantly associated with increased one-year mortality (aOR: 1.089, p=0.905).
- No 30-day mortality was observed in either the daytime or nighttime surgery groups.
Conclusions:
- No significant increase in long-term or one-year mortality was associated with nocturnal elective CABG operations.
- Further prospective randomized studies are needed to confirm these findings and evaluate the economic impact of nocturnal surgeries.
Background:
Elective coronary artery bypass grafting (CABG) surgeries are increasingly scheduled during nighttime or after-hours. This poses unique challenges, such as reduced staffing, disrupted circadian rhythms, and increased fatigue, which may potentially affect outcomes. Despite growing evidence on the impact of daytime on cardiac surgery outcome, results remain inconclusive. The current study aims to investigate a potential association between surgery timing (daytime: 7:00 AM to 7:00 PM vs. nighttime: 7:00 PM to 7:00 AM) and long-term survival in patients undergoing elective CABG.
Methods:
In this retrospective single-institution cohort study at the University Clinic Salzburg, Austria, we analyzed elective CABG surgeries performed between January 1, 2017, and December 31, 2021. The primary hypothesis was that nighttime elective CABG surgeries have worse long-term survival. Among 2,179 cardiac surgical procedures, 723 elective CABG surgeries were identified and analyzed. Long-term survival was assessed using Cox proportional hazard modeling, while secondary outcomes, including 30-day and one-year mortality rates, were evaluated through multiple linear regression analysis.
Results:
The one-year mortality rate was 2.6% (n = 19) for the observation period. Of the 723 patients, 646 (89.35%) underwent daytime surgery, and 77 (10.65%) had nighttime surgery. The median EuroScore II was 1.50 [1.00, 2.60] for daytime surgeries and 1.70 [1.10, 3.10] for nighttime surgeries (p = 0.111). There was no association between nighttime surgery and long-term mortality (aHR: 1.624, 95% CI: 0.589 to 3.662, p = 0.3179). Multivariable logistic regression analysis confirmed that nighttime surgeries were not significantly associated with increased one-year mortality (aOR: 1.089, 95% CI: 0.208 to 3.711, p = 0.905). No deaths occurred within 30 days in either group.
Conclusion:
This analysis found no significant association between nocturnal elective CABG operations and increased long-term or one-year mortality. This study did not aim to evaluate the economics of nocturnal surgeries at the investigated institution. To confirm our results that there is no increased morbidity and mortality associated with nocturnal CABG operations, and to understand the economic impact of nocturnal surgeries, prospective randomized studies would be necessary.
