Comparison of nighttime and daytime operation on outcomes of kidney transplant with deceased donors

Abstract

Background: Kidney transplant is always emergent operations and frequently need to be performed at nighttime to reduce cold ischemia time (CIT). Previous studies have revealed that fatigue and sleep deprivation can result in adverse consequences of medical procedures. This study aimed to evaluate whether nighttime operation has adverse impact on kidney transplant. Methods: A retrospective analysis of recipients accepted kidney transplant from deceased donors in one center from 2014 to 2016 was performed. Daytime transplant was defined as operation started after 8 am or ended before 8 pm and nighttime operation was defined as operation ended after 8 pm or started before 8 am . The incidences of complications such as delayed graft function, acute rejection, surgical complications and nosocomial infections were compared between 2 groups. Student's t -test was used to analyze continuous variables such as serum creatinine (Scr) at 1-year of post-transplant. The Chi-square test was used to analyze categorical variables. Differences in recipients and graft survival were analyzed using Kaplan–Meier methodology and log-rank tests. Results: Among the 443 recipients, 233 (52.6%) were classified into the daytime group and the others 210 (47.4%) were in the nighttime group. The 1-year survival rate of recipients was similar for the recipients in the daytime and nighttime groups (95.3% vs. 95.2%, P = 0.981). Although the 1-year graft survival rate in the nighttime group was slightly superior to that in the daytime group, the difference was not significant (92.4% vs. 88.4%, P = 0.164). Furthermore, Scr and incidence of complications were also not significantly different between the 2 groups. Conclusions: Our results suggested that operation time of kidney transplant with short CIT has no significant impact on the outcome of kidney transplant. Nighttime operation of kidney transplant with short CIT could be postponed to the following day to alleviate the burden on medical staffs and avoid the potential risk.

Is night‐time surgical procedure for renal graft at higher risk than during the day? A single center study cohort of 179 patients

“…That time is crucial, with a transfer of all the perioperative informations between teams, and can lead to transmission error. Giugale et al 18 showed an increase surgery time in the nurse handoff period, but no major CD complications associated during that time. Other studies reported higher risk of postoperative complications or even mortality when anaesthetic handover was done during cardiac surgery.…”

Day-Time Declamping Is Associated with Better Outcomes in Kidney Transplantation: The Circarein Study

“…First, a human factor can be at play: Less efficiency of the surgeon and/or medical care in the night period might induce prolonged ischemia duration and higher rates of technical failure. The few studies that previously investigated the impact of off-duty kidney transplantation did not show consistent data supporting such a fatigue effect [ 2 , 3 , 4 , 5 , 6 , 7 , 8 ]. Although Flechner et al showed that transplantations performed between 8 pm and 8 am result in a higher risk for 5-year graft failure [ 2 ], Özdemir-van Brunschot et al did not report such an off-hour impact in a larger population with an unexpected lower incidence of pure technical graft failure at night [ 3 ].…”

“…However, off-hour surgery may result in lower performance of medical care due to staff fatigue. The net result of these two opposing factors on outcomes has only been explored in a few small studies focusing on graft declamping time-of-the-day, which reported inconsistent, and sometimes counter-intuitive results (e.g., less technical failure at night) [ 2 , 3 , 4 , 5 , 6 , 7 , 8 ]. Importantly, time-of-the-day has been demonstrated to impact organ tolerance to IR injury [ 9 ].…”

Will surgeries performed at night lead to worse outcomes? Findings from a trauma center in Riyadh

“…[ 33 ] In addition, in a paper [ 34 ] that surveyed 27,305 cardiac surgery patients between 2010 and 2017 to compare morning and afternoon cardiac surgeries (procedures that included coronary artery bypass graft with internal mammary, or thoracic artery and vein or radial artery bypass) in regard to surgical site infections and mortality, the conclusion was that current evidence is not enough to favor afternoon cardiac surgeries, and that increased rates of morning myocardial infarction were not associated with an impact on the 1-year deep surgical site infections or mortality rate. Furthermore, there are a number of studies [ 35 – 37 ] of different transplant surgical procedures that have concluded that there is no higher risk, no poorer outcomes, and no adverse complications during nighttime surgeries compared to daytime.…”