Postoperative Outcomes Following Preweekend Surgery
1. Patients who underwent surgery immediately before the weekend had an increased risk of complications, readmissions, and mortality compared with those treated after the weekend.
Evidence Rating Level: 2 (Good)
The weekend effect refers to a higher potential for adverse outcomes in patients receiving care over the weekends compared to weekdays. Given the limited research on its impact on postoperative outcomes, this retrospective cohort study thus examined differences in postoperative outcomes among patients who underwent surgical procedures immediately before versus after the weekend. This study used data from multiple health care databases and included adult patients (>18 years) in Ontario, Canada, who underwent one of 25 common surgical procedures between January 1, 2007 and December 31, 2019. The preweekend group included patients who underwent surgery the day before the weekend or long weekend, and the postweekend group included those who underwent surgery the day after the weekend or long weekend. Of the 429, 691 patients included in the study (mean [SD] age, 58.6 [16.9] years; 270, 002 female patients [62.8%]), 199, 744 (46.5%) underwent surgery before the weekend, and 229 947 (53.5%) underwent surgery after the weekend. Compared to the postweekend group, patients in the preweekend group were more likely to experience the composite outcome of death, complications, and readmissions at 30 days (adjusted odds ratio [aOR], 1.05; 95% CI, 1.02-1.08), 90 days (aOR, 1.06; 95% CI, 1.03-1.09), and 1 year after surgery (aOR, 1.05; 95% CI, 1.02-1.09). The preweekend group also had greater odds of mortality than the postweekend group at 30 days (aOR, 1.09; 95% CI, 1.03-1.16), 90 days (aOR, 1.10; 95% CI, 1.03-1.17), and 1 year (aOR, 1.12; 95% CI, 1.08-1.17). Overall, this study found that patients who underwent surgery immediately before the weekend had 5% higher odds of short- and long-term adverse postoperative outcomes, including complications, readmissions, and mortality, compared to those treated after the weekend. Future studies are needed to investigate the differences in care underpinning these findings.
Sleep Characteristics and Long-Term Risk of Type 2 Diabetes Among Women With Gestational Diabetes
1. Short sleep duration ( < 6 hours per day) and regular or occasional snoring were associated with a higher risk of Type 2 Diabetes among women with a history of Gestational Diabetes (GD).
2. More frequent snoring was associated with an unfavorable metabolic profile.
Evidence Rating Level: 2 (Good)
Women with a history of gestational diabetes (GD) are nearly 10 times more likely to develop type 2 diabetes (T2D) later in life than those without GD history. Although shortened sleep duration has been associated with an increased risk of T2D, research on the role of sleep in the progression from GD to T2D is lacking. This prospective cohort study thus examined the associations of sleep duration and quality with the risk of T2D in women with a history of GD. This study analyzed data from the Nurses’ Health Study II, an ongoing prospective cohort study of female nurses aged 22-44, and included women who reported a history of GD on the questionnaire administered between June 2002 and June 2003. Women in the study were followed up biennially until June 2021. Among the 2,891 women with a history of GD included (mean [SD] age, 45.3 [4.4] years), 563 women (19.5%) developed T2D over 42,155 person-years of follow-up (mean [SD] follow-up duration, 17.3 [5.1] years). Compared with women who reported rarely snoring, those with occasional or regular snoring had a higher risk of T2D, with adjusted hazard ratios (HRs) of 1.54 (95% CI, 1.18-2.02) and 1.61 (95% CI, 1.21-2.13), respectively. Compared with women who slept 7 to 8 hours per day, those who slept less (<6 hours per day) had a higher risk of T2D (HR, 1.32; 95% CI, 1.06-1.64). Women who both slept < 6 hours per day and snored regularly had the highest risk of developing T2D (HR, 2.06; 95% CI, 1.38-3.07) compared with women who slept 7 to 8 hours per day and almost never snored. Compared with women who rarely snored, more frequent snoring was also associated with higher levels of glycated hemoglobin (HbA1c) (least-squares means [LSM], 5.89; 95% CI, 5.75-6.02), C-peptide (LSM, 4.30; 95% CI, 3.70-4.99), and insulin levels (LSM, 11.25; 95% CI, 8.75-14.40) (P = .01 for all). Overall, this study found that short sleep durations of < 6 hours per day and frequent snoring were associated with an increased risk of T2D among women with a history of GD, and that snoring frequency was also linked to an unfavorable metabolic profile. These results suggest that improving sleep health may be important in preventing progression from GD to T2D.
1. Older age, hypnotic drug use, and higher intraoperative fluid load were independent risk factors associated with postoperative delirium development after pancreatic surgery.
Evidence Rating Level: 2 (Good)
Postoperative delirium is common after major surgery and can lead to other postoperative complications, prolonged hospital stays, and higher hospital costs. While previous studies have reported risk factors for postoperative delirium, research specifically on those following pancreatic surgery remains limited. This study thus aimed to identify risk factors for postoperative delirium in patients who underwent pancreatic surgery. This retrospective, single-center study included adult patients (>18 years) who underwent pancreatic surgery between July 2020 and March 2021 in a hospital in Shanghai, China. Postoperative delirium was assessed with the Confusion Assessment Method twice a day up to postoperative day 7. In total, 385 patients (mean [SD] age, 58.33 [13.41]; 202 [52.5%] male) were included in the study, of which 59 (15.3%) developed postoperative delirium after pancreatic surgery. Independent risk factors of postoperative delirium were found include age (≥ 65 years) [Odds ratio (OR) 2.01; 95% Confidence interval (CI) 1.12-3.63; p = 0.019], hypnotic drug use (OR 4.17; 95% CI 1.50-11.10; p = 0.005), and intraoperative fluid balance (OR 2.57; 95% CI 1.37-4.84; p = 0.003). Overall, study results suggest that managing intraoperative fluid load along with standardized perioperative programs may be important in reducing postoperative delirium risk, especially in high-risk patients such as those with advanced age or a history of hypnotic drug use. Future is needed to validate study findings.
1. People receiving acute hospital care for hallucinogen use had an increased risk of mortality compared with the general population.
Evidence Rating Level: 2 (Good)
The global use of hallucinogens has rapidly increased since the mid-2010s. While many clinical trials support the therapeutic use of hallucinogens in mental and substance use disorders, concerns remain regarding the increased risk of serious adverse events, including suicidality and death, especially outside of supervised clinical settings. Furthermore, research on the link between hallucinogen use and mortality risk remains limited. This study thus examined whether people with an emergency department visit or hospital admission involving hallucinogen use were at increased risk of all-cause death compared with the general population. This retrospective cohort study used linked administrative data on individuals aged 15 years and older living in Ontario, Canada, from January 2006 to December 2021, with mortality follow-up until December 2022. In the primary analysis, people with acute care involving hallucinogens were matched to the general population on age, sex, and index date. Of the 11,415, 713 people included in the study, 7,953 (0.07%) had incident acute care involving hallucinogens (mean age, 27.8; 5587 male [70.3%]). The matched analysis included 77,101 people (mean age, 27.7; 54, 233 male [70.3%]) with a median follow-up of 7 (interquartile range 3–11) years. Acute care involving hallucinogens was associated with a 2.6-fold increased all-cause mortality within 5 years (hazard ratio [HR] 2.57, 95% confidence interval [CI] 2.09–3.15), with absolute risk of 6.1% (n = 482) compared to 0.6% in the general population (n = 460). Similar results were found after excluding people with comorbid mental or substance use disorders (HR 3.25, 95% CI 2.27–4.63). Furthermore, relative to the general population, people with acute care involving hallucinogens had a higher risk of death by unintentional drug poisoning (HR 2.03, 95% CI 1.02–4.05), suicide (HR 5.23, 95% CI 1.38–19.74), respiratory disease (HR 2.46, 95% CI 1.18–5.11), and cancer (HR 2.88, 95% CI 1.61–5.14). Overall, this study found that people receiving acute hospital care for hallucinogen use had an increased risk of mortality compared with the general population. Considering the growing use of hallucinogens outside of clinical settings, these findings may be important in clinical and policy decision-making.
1. Among patients with ovulatory dysfunction, dominant follicles measuring 17–18.9 mm were associated with poorer pregnancy outcomes compared to follicles ≥ 19 mm.
2. Among patients with unexplained infertility, dominant follicles > 21 mm were associated with a lower positive HCG rate compared to follicles measuring 17–21 mm.
Evidence Rating Level: 2 (Good)
Intrauterine insemination with ovulation induction (OI-IUI) is a widely used fertility treatment. Letrozole (LE), a third-generation aromatase inhibitor, is a commonly used medication for ovulation induction. However, research on the optimal dominant follicle size for triggering ovulation in LE-IUI cycles remains limited and inconclusive. This study thus aimed to determine the optimal dominant follicle size on the trigger day in patients with ovulatory dysfunction (OD) and unexplained infertility (UI) undergoing intrauterine insemination with letrozole (LE-IUI) cycles. This retrospective study included females under 40 years of age with OD or UI who underwent LE-IUI at a reproductive medicine center in Guangzhou, China. Participants were propensity matched 1:1 for baseline characteristics. Out of the 693 cycles of OD and 580 cycles of UI initially screened for this study, 411 cycles of each group were analyzed after propensity matching (OD: mean [SD] age, 31.02 [3.44]; UI: mean [SD] age, 31.20 [3.43]). Compared to the UI group, the OD group had higher rates of human chorionic gonadotropin (HCG) positive (22.4% vs. 9.5%), clinical pregnancy (21.5% vs. 7.9%), and live birth (19% vs. 7.1%) (P < 0.001 for all). In the OD group, patients with dominant follicle size 17–18.9 mm had lower rates of HCG positive, clinical pregnancy, and live birth compared to those with dominant follicle size 19–21.0 mm and > 21.0 mm (HCG positive: 7.6% vs. 21.5% vs. 26.2%; clinical pregnancy: 6.1% vs. 21.5% vs. 25.6%, live birth: 4.5% vs. 19.2% vs. 23.2%; P < 0.05 for all). Conversely, in the UI group, those with dominant follicle size > 21.0 mm had lower HCG positive rates (13.3% vs. 11.8% vs. 3.4%, P = 0.023) compared to those with dominant follicle size 17–18.9 mm and 19–21.0 mm. Overall, study results suggest that the optimal dominant follicle size for triggering ovulation is ≥ 19.0 mm for patients with ovulatory dysfunction, while a size ≤ 21 mm may improve HCG positive rates for patients with unexplained infertility. These findings highlight the importance of considering the underlying cause of infertility when determining trigger timing. Future randomized control trials are needed to validate study findings.
Image: PD
©2025 2 Minute Medicine, Inc. All rights reserved. No works may be reproduced without expressed written consent from 2 Minute Medicine, Inc. Inquire about licensing here. No article should be construed as medical advice and is not intended as such by the authors or by 2 Minute Medicine, Inc.