ArticleThe Lancet regional health. Europe2021
Daytime and outcomes after cardiac surgery: Systematic review and metaanalysis, insights from a large UK database review and post-hoc trial analysis.
Article in The Lancet regional health. Europe, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers.
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Who cites it
12 citing papers in PubMed, 17 citations in OpenAlex.
- Time of day of cardiac surgery and postoperative outcomes: exploratory findings require caution.Anaesthesia · 2026Article
- Circadian regulation of cardiovascular function: from physiology to clinical implications.Genome medicine · 2026Review
- Time of day of cardiac surgery and postoperative outcomes in the UK: a secondary analysis of linked national datasets.Anaesthesia · 2026Article
- Design considerations for hypertension chronotherapy trials: insights from experience and modelling.BMC medicine · 2026Review
- Circadian variation of post-operative complications in lung resection surgery.Frontiers in physiology · 2026Article
- Impact of the Circadian Rhythm and Seasonal Changes on the Outcome of Cardiovascular Interventions.Journal of clinical medicine · 2025Review
- Nocturnal elective coronary artery bypass grafting (CABG) surgery is not associated with increased one-year mortality.Patient safety in surgery · 2025Article
- Daytime variation of in-hospital mortality and low cardiac output syndrome after pediatric cardiac surgery-a retrospective cohort study.Annals of medicine · 2024Article
- Circadian rhythm and daytime variation do not affect intraoperative bacterial sternal contamination and postoperative wound infections following cardiac surgery.Scientific reports · 2024Article
- The Cardiac Circadian Clock: Implications for Cardiovascular Disease and its Treatment.JACC. Basic to translational science · 2023Review
- The Role of Circadian Clock Genes in Critical Illness: The Potential Role of Translational Clock Gene Therapies for Targeting Inflammation, Mitochondrial Function, and Muscle Mass in Intensive Care.Journal of biological rhythms · 2022Review
- Cardiac surgery in the morning or not in the morning:"When?" is the question.The Lancet regional health. Europe · 2021Article
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Authors and funding
7 authors at 1 institution in 1 country.
Funding
Abstract
backgroundSeveral studies have suggested a variation of myocardial tolerance to ischaemia depending on the daytime of surgery. To test this hypothesis, we conducted a three-level analysis: metaanalysis, national patient-level dataset analysis and a post-hoc trial analysis.
methodsWe first performed a systematic review and metaanalysis of available studies comparing clinical outcomes following cardiac surgery performed in the morning (am) versus afternoon (pm). Then, we interrogated the UK national adult cardiac surgery audit database (NACSA) and analysed the am or pm outcomes of patients undergoing non-emergency aortic valve replacement (AVR) or coronary artery bypass grafting (CABG). In a post-hoc analysis, we further investigated the effect of time of surgery on serum troponin release and ventricular myocardial biopsy adenine nucleotide metabolism.
resultsA total of 18377 patients undergoing uncomplicated isolated CABG or isolated AVR on the same day am or pm were included in the metaanalysis. Meta-analytic estimates showed no difference in the risk of MI between patients operated in pm vs am (OR 1.02, 95% CI:0.79-1.32) and in the risk of mortality (OR 1.1, 95% CI:0.85-1.42). Outcomes of 91248 patients from the NACSA dataset were analysed according to the daytime of the procedure. Patient-level analysis showed no significant effect of daytime for both isolated AVR (p=0.094) and isolated CABG (p=0.425). Finally, we performed a post-hoc trial database analysis in 124 patients undergoing isolated AVR or CABG of serial cardiac troponin and nucleotides metabolism on ventricular myocardial biopsies. We found no significant diurnal changes in the perioperative cardiac troponin release or nucleotide metabolism in the AVR (p=0.30) or the CABG cohort (p=0.97).
conclusionThe present three-level analysis found no evidence that daytime influences clinical outcomes and myocardial injury in patients undergoing cardiac surgery.
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