JAMA Network Open最新文献

Importance: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have been increasingly prescribed for weight management in recent years. However, little is known about whether preoperative GLP-1 RA use is associated with a greater risk of complications after surgery.

Objective: To investigate whether preoperative GLP-1 RA use is associated with postoperative aspiration pneumonia among patients undergoing common surgical procedures.

Design, setting, and participants: This retrospective cohort study, conducted using MarketScan commercial claims databases, included patients who underwent 1 of 14 common surgical procedures from April 1, 2020, to September 30, 2022. Individuals who were younger than 18 years, underwent multiple surgical procedures, or had a preoperative history of pneumonia or acute respiratory failure in the 90 days preceding surgery were excluded. Data were analyzed from December 2023 to March 2024.

Main outcome and measures: The primary outcome was aspiration pneumonia in the 30-day postoperative period. Multivariable logistic regressions were performed, adjusting for patient and surgical characteristics.

Results: This study included 366 476 patients (median age, 53 years [IQR, 43-62 years]), of whom 56.4% were women. In the cohort, 5931 patients (1.6%) had a preoperative prescription for a GLP-1 RA. Patients using GLP-1 RAs were more likely to be female (3502 [59.0%] vs 203 288 [56.4%]) and diagnosed with both obesity and diabetes (2819 [47.5%] vs 24 635 [6.8%]) compared with nonusers. Adjusted analysis showed no significant differences in the odds of postoperative pneumonia (odds ratio, 0.78; 95% CI, 0.57-1.06; P = .12) between GLP-1 RA users and nonusers.

Conclusions and relevance: This cohort study found no significant association between the preoperative use of GLP-1 RAs and short-term postoperative aspiration pneumonia despite growing concerns about the adverse effects of these medications after surgery. This finding suggests that it may be beneficial to reassess the preoperative withholding guidelines for GLP-1 RAs.

Importance: The phenomenon of a weekend effect refers to a higher potential for adverse outcomes in patients receiving care over the weekend. Few prior studies have comprehensively investigated the effects of postoperative weekend care on surgical outcomes in a generalizable cohort.

Objective: To examine differences in short-term and long-term postoperative outcomes of patients undergoing surgical procedures immediately before vs after the weekend.

Design, setting, and participants: This is a population-based, retrospective cohort secondary analysis of adult patients in Ontario, Canada, undergoing 1 of 25 common surgical procedures between January 1, 2007, to December 31, 2019, with 1 year of follow-up. Data analysis was performed from October to November 2022.

Exposure: Undergoing surgery before (1 day before) vs after (1 day after) the weekend.

Main outcomes and measures: The primary outcome was a composite of death, readmission, and complications at 30 days, 90 days, and 1 year. Multivariable generalized estimating equations with an independent correlation structure, accounting for covariates, with clustering on surgical procedure were used to estimate the association between day of surgery in relation to the weekend and the outcomes.

Results: Of the 429 691 patients (mean [SD] age, 58.6 [16.9] years; 270 002 female patients [62.8%]) in the study cohort, 199 744 (46.5%) underwent surgery before the weekend, and 229 947 (53.5%) underwent surgery after the weekend. Patients in the preweekend group were more likely than those in the postweekend group 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 (aOR, 1.05; 95% CI, 1.02-1.09) after surgery. Odds of mortality were increased in the preweekend group vs 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).

Conclusions and relevance: In this retrospective multi-institutional study, patients who underwent surgery immediately preceding the weekend had a significantly increased risk of complications, readmissions, and mortality compared with those treated after the weekend. Further study is needed to understand differences in care that may underpin these observations and ensure that patients receive high-quality care regardless of the day of the week.

Importance: Understanding the interplay between trajectories of sleep duration, sleep onset timing, and glycemic dynamics is crucial for improving preventive strategies against diabetes and related metabolic diseases.

Objective: To examine the associations of sleep duration and onset timing trajectories with continuous glucose monitoring (CGM)-derived glycemic metrics in adults.

Design, setting, and participants: This cohort study analyzed data collected from January 2014 to December 2023 in the Guangzhou Nutrition and Health Study, a prospective cohort in Guangdong province, China, among participants aged 46 to 83. Participants who had repeated sleep assessments at several study visits and were equipped with CGM devices at the last visit were included. Data analyses were conducted between January and June 2024.

Exposures: The trajectories of sleep duration and onset timing were constructed using self-report sleep duration and sleep onset timing, recorded at multiple study visit points.

Main outcomes and measures: Measurements of glycemic variability and glycemic control were collected using a masked CGM device worn by patients for 14 consecutive days. Huber robust regression models were used to assess the associations between sleep trajectories and CGM-derived metrics.

Results: In this study of 1156 participants (mean [SD] age, 63.0 [5.1] years, 816 [70.6%] women), we identified 4 distinct sleep duration trajectory groups: severe inadequate, moderate inadequate, mild inadequate, and adequate. Severe sleep inadequacy was associated with an increment of glycemic variability indicators: 2.87% (95% CI, 1.23%-4.50%) for coefficient of variation and 0.06 (95% CI, 0.02-0.09) mmol/L for mean of daily differences. We found 2 trajectories of sleep onset timing: persistent early and persistent late groups. Late sleep onset was associated with larger coefficient of variation (β = 1.18%; 95% CI, 0.36%-2.01%) and mean of daily differences (β = 0.02 mmol/L; 95% CI, 0.01-0.04 mmol/L). Inappropriate sleep duration and timing trajectories in combination were associated with greater glycemic variability.

Conclusions and relevance: In this cohort study of middle-aged and older participants, persistent inadequate sleep duration and late sleep onset, whether alone or in combination, were associated with greater glycemic variability. These findings emphasize the importance of considering both sleep duration and timing for optimizing glycemic control in the general population.