BACKGROUND: The aim of this post hoc analysis of a large cohort study was to evaluate the association between night-time surgery and the occurrence of intraoperative adverse events (AEs) and postoperative pulmonary complications (PPCs). METHODS: LAS VEGAS (Local Assessment of Ventilatory Management During General Anesthesia for Surgery) was a prospective international 1-week study that enrolled adult patients undergoing surgical procedures with general anaesthesia and mechanical ventilation in 146 hospitals across 29 countries. Surgeries were defined as occurring during 'daytime' when induction of anaesthesia was between 8:00 AM and 7:59 PM, and as 'night-time' when induction was between 8:00 PM and 7:59 AM. RESULTS: Of 9861 included patients, 555 (5.6%) underwent surgery during night-time. The proportion of patients who developed intraoperative AEs was higher during night-time surgery in unmatched (43.6% vs 34.1%; P<0.001) and propensity-matched analyses (43.7% vs 36.8%; P=0.029). PPCs also occurred more often in patients who underwent night-time surgery (14% vs 10%; P=0.004) in an unmatched cohort analysis, although not in a propensity-matched analysis (13.8% vs 11.8%; P=0.39). In a multivariable regression model, including patient characteristics and types of surgery and anaesthesia, night-time surgery was independently associated with a higher incidence of intraoperative AEs (odds ratio: 1.44; 95% confidence interval: 1.09-1.90; P=0.01), but not with a higher incidence of PPCs (odds ratio: 1.32; 95% confidence interval: 0.89-1.90; P=0.15). CONCLUSIONS: Intraoperative adverse events and postoperative pulmonary complications occurred more often in patients undergoing night-time surgery. Imbalances in patients' clinical characteristics, types of surgery, and intraoperative management at night-time partially explained the higher incidence of postoperative pulmonary complications, but not the higher incidence of adverse events. CLINICAL TRIAL REGISTRATION: NCT01601223.

• Keywords
• general anaesthesia, intraoperative complications, patient safety, postoperative complications, pulmonary,
• MeSH
• Surgical Procedures, Operative * MeSH
• Adult MeSH
• Incidence MeSH
• Internationality MeSH
• Cohort Studies MeSH
• Middle Aged MeSH
• Humans MeSH
• Intraoperative Complications epidemiology   MeSH
• Lung Diseases epidemiology   MeSH
• After-Hours Care statistics & numerical data   MeSH
• Postoperative Complications epidemiology   MeSH
• Prospective Studies MeSH
• Risk Factors MeSH
• Aged MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Multicenter Study MeSH
• Observational Study MeSH

• MeSH
• Time Factors MeSH
• Tertiary Care Centers statistics & numerical data   MeSH
• Humans MeSH
• Infant, Newborn MeSH
• Outpatients statistics & numerical data   MeSH
• Infant Care statistics & numerical data   MeSH
• After-Hours Care statistics & numerical data   MeSH
• Triage MeSH
• Check Tag
• Humans MeSH
• Infant, Newborn MeSH
• Publication type
• Letter MeSH
• Geographicals
• Ireland epidemiology   MeSH

BACKGROUND: Computed tomography (CT) is widely available in most hospitals, usually 24 h a day, which results in an expansion of its indications, sometimes beyond medically justifiable extent. AIM: To evaluate trends in emergency cranial CTs in a general university hospital during the last 15 years. METHODS: We conducted a database search for emergency cranial CTs between January 2000 and December 2015 that were performed in patients after head injury on weekends and bank holidays and between 8 P.M. and 6 A.M. on workdays. The numbers were compared with demographic data, the number of hospital beds, and total number of CT examinations. RESULTS: The annual number of emergency cranial CTs increased 5.5 times from 124 to 679 with a sharp increase since 2013. This trend showed a negative correlation with the number of hospital beds (r = -0.88, p = 0.0001), the proportion of important findings on cranial CT (r = -0.74, p = 0.0010), or the proportion of patients indicated for cranial CT by NICE 2014 criteria (r = -0.90, p < 0.0001) and positive correlation with the proportion of inebriated patients (r = 0.94, p < 0.0001), and their average GCS score (r = 0.92, p < 0.0001). Compared to the number of emergency cranial CTs, the slope of regression lines for all trends was significantly different (p < 0.001) apart from the number of inebriated patients (p = 0.062). CONCLUSIONS: The increase in the emergency cranial CTs cannot be entirely justified by their clinical need. We assume that this is the result of an absent support of adherence to the guidelines in the legislation together with a medicolegally unpredictable environment.

• Keywords
• Computed tomography, Emergency, Head, Trauma, Trend,
• MeSH
• Craniocerebral Trauma diagnostic imaging   epidemiology   MeSH
• Middle Aged MeSH
• Humans MeSH
• Hospital Bed Capacity statistics & numerical data   MeSH
• Needs Assessment MeSH
• Tomography, X-Ray Computed statistics & numerical data   MeSH
• After-Hours Care statistics & numerical data   MeSH
• Utilization Review MeSH
• Prevalence MeSH
• Unnecessary Procedures statistics & numerical data   MeSH
• Retrospective Studies MeSH
• Risk Factors MeSH
• Emergency Medical Services statistics & numerical data   MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Geographicals
• Czech Republic epidemiology   MeSH