Surgery performed at night by continuously working surgeons contributes to a higher incidence of intraoperative complications in video-assisted thoracoscopic pulmonary resection: a large monocentric retrospective study

Chunji Chen; Xiaofeng Zhang; Chang Gu; Yiyang Wang; Kun Liu; Xufeng Pan; Shijie Fu; Limin Fan; Rui Wang

doi:10.1093/ejcts/ezz253

Surgery performed at night by continuously working surgeons contributes to a higher incidence of intraoperative complications in video-assisted thoracoscopic pulmonary resection: a large monocentric retrospective study

Eur J Cardiothorac Surg. 2020 Mar 1;57(3):447-454. doi: 10.1093/ejcts/ezz253.

Authors

Chunji Chen¹, Xiaofeng Zhang², Chang Gu³, Yiyang Wang¹, Kun Liu², Xufeng Pan¹, Shijie Fu¹, Limin Fan¹, Rui Wang¹

Affiliations

¹ Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.
² Department of Anesthesiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.
³ Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Shanghai Tongji University, Shanghai, China.

PMID: 31539044
DOI: 10.1093/ejcts/ezz253

Abstract

Objectives: Our goal was to assess the influence of working hours and working at night on intraoperative complications on surgeons conducting video-assisted pulmonary resections.

Methods: We identified all patients who underwent video-assisted thoracoscopic surgery (VATS) in Shanghai Chest Hospital from January 2015 to April 2017. Univariable and multivariable logistic analyses were used to analyse independent risk factors for intraoperative complications. A 1:4 propensity score matching analysis was conducted to verify those results.

Results: A total of 15 767 patients who underwent VATS pulmonary resection were included in this study. Among them, 15 280 patients (96.1%) were operated on during daytime working hours and 487 (3.1%) at night. A total of 203 (1.3%) intraoperative complications occurred. Vascular injury was the main cause of intraoperative complications, accounting for 92.1% (187/203). Multivariable logistic regression indicated that age [odds ratio (OR) = 1.68, 95% confidence interval (CI) 1.43-1.98; P < 0.001], gender (OR = 1.71, 95% CI 1.26-2.32; P = 0.001), surgical experience (OR = 2.07, 95% CI 1.56-2.75; P < 0.001), type of surgery (OR = 0.31, 95% CI 0.20-0.49; P < 0.001) and operative periods (OR = 2.69, 95% CI 1.61-4.86; P < 0.001) were independent predictors for intraoperative complications. The incidence of intraoperative complications during night-time surgery was significantly higher than that during daytime working hours. A 1:4 propensity score matching-based results verification showed that night-time surgery was still an independent risk factor after propensity score matching (OR = 2.76, 95% CI 1.47-5.15; P = 0.002).

Conclusions: The incidence of intraoperative complications from VATS pulmonary resection performed during night hours was significantly higher than that performed during working hours. In the present labour environment, thoracic surgeons should avoid night-time surgery whenever possible.

Keywords: Intraoperative complications; Night-time surgery; Video-assisted thoracoscopic pulmonary resection.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

China / epidemiology
Humans
Incidence
Intraoperative Complications / epidemiology
Intraoperative Complications / etiology
Lung Neoplasms* / surgery
Pneumonectomy
Postoperative Complications / epidemiology
Postoperative Complications / etiology
Retrospective Studies
Surgeons*
Thoracic Surgery, Video-Assisted / adverse effects