Surgical risks: something else you need to know

Time of day affects the results of surgical procedures. Almost any work done at night has 20150317_CDC_Concussiona higher risk of complications.

Previous studies have documented the relationship between surgical and medical management of diseases at night leading to worse outcome and it has particularly been exemplified in those undergoing: coronary angioplasty, orthopedic surgery, transplant surgery, colorectal surgery, and cardiac arrest patients.(1)

The newest study documents similar effects for patients undergoing neurosurgery.

The study showed that the odds of a complication were increased by more than 50% for procedures with start times between 9 pm and 7 am. When accounting for the length of the surgery, the odds of a complication were even greater for later time periods. The only statistically significant factor that predicted severity of the complication was if the operation was an emergency compared to an elective surgery.(1)

There are two possible explanations for the greater level of errors on the graveyard shift.

  • Hypothesis 1: Medical practitioners are fatigued later in the day, putting them at greater risk of errors.
  • Hypothesis 2: The best people work their way into the best shifts. Night shift staff tend to be less experienced and thus more prone to errors.

Emergencies are likely to land with whoever is available, and it makes sense that newer medical people would have greater availability.

We don’t actually know which hypothesis is true, or the results could be a combination of both factors. Regardless, you want to avoid night shift surgeries if at all possible. If hypothesis 1 is true, then it should be best to be the first surgery scheduled for the day. And be careful: emergencies aren’t fun.

Any doctors or patients care to comment?

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Source:  Joseph R. Linzey, James F. Burke, M. Amr Sabbagh, Stephen Sullivan, B. Gregory Thompson Karin M. Muraszko, Aditya S. Pandey. The Effect of Surgical Start Time on Complications Associated With Neurological Surgeries. Neurosurgery, 2017 DOI: 10.1093/neuros/nyx485

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