Effect of Daytime Versus Night-time on Outcome in Patients Undergoing Emergent Neurosurgical Procedures

Abstract

Background:Timing of neurosurgical procedures is controversial. Challenges identified with night-time surgeries include physician fatigue and sleep deprivation, and fewer staff and resources compared with daytime surgery. These might contribute to medical errors and complications, and, hence, worse patient outcomes.Methods:This single center retrospective study of 304 patients who underwent emergent neurosurgical procedures between January 1, 2010 and December 31, 2016 included 2 groups based on the timing of surgery: daytime (7:00 amto 6:59 pm) and night-time (7:00 pmto 6:59 am) surgery groups. Patient demographics, diagnosis, surgical characteristics, complications, and neurological outcome were obtained from the medical records.Results:There was no difference in patient demographics, intraoperative complications, and length of surgery between the 2 groups. Although there was no statistically significant difference in neurological outcome between the 2 groups at hospital discharge and 1 month postdischarge, there was a higher proportion of patients in the night-time surgical group with unfavorable neurological outcome (Glasgow Outcome Score 1 to 3) at both these times. There were differences in hospital length of stay, location of postoperative management (postanesthesia care unit or intensive care unit), midline shift, baseline Glasgow Coma Scale score, and acuity of surgery between the 2 groups. Logistic regression analysis showed that age, baseline Glasgow Coma Scale score, surgery acuity status, procedure type, and intraoperative complications influenced neurological outcome.Conclusions:This study found no difference in the rate of unfavorable neurological outcome in patients undergoing emergent neurosurgical procedures during the daytime and night-time. However, our findings cannot exclude the possibility of an association between timing of surgery and outcome given its limitations, including small sample size and omission of potentially confounding variables. Further well-designed prospective trials are warranted to confirm our findings.

Time-of-day discrepancy for the long-term surgical outcome of patients with aortic dissection

“…Theoretically, major bleeding resulting from the reduction of carefulness and patience of relevant staff due to staff fatigue was once a concerning factor for outcome during nighttime surgeries [ 15 , 16 ]. Moreover, patients transferred to the ICU after nighttime surgery were often intentionally delayed in the removal of mechanical intubation, which was also a concerning factor for outcome during nighttime surgeries [ 17 ].…”

Year in Review: Synopsis of Selected Articles in Neuroanesthesia and Neurocritical Care from 2020

“…This study investigated the role of diurnal variation on the outcome of emergent neurosurgical procedures. 4 The patient cohort consisted of two groups, "daytime" (7:00 a.m. to 6:59 p.m.) group (n = 199) and "night-time" (7:00 p.m. to 6:59 a.m.) group (n = 105). Primary outcome of the study was the neurological outcome at discharge (Glasgow Outcome Scale [GOS]) that was dichotomized into "favorable" (GOS 4 or 5-moderate disability or good recovery) and "unfavorable" (GOS 1-3-death, persistent vegetative state, or severe disability) outcomes.…”

Association Between Daytime vs Overnight Digit Replantation and Surgical Outcomes

“…We conducted a retrospective case series study at a tertiary care academic center to assess surgical time, categorized as either daytime or overnight, and replantation outcomes. We investigated surgical timing and replantation outcomes using previously described time intervals 20,22,[26][27][28][29][30]32,37,41,[43][44][45][46][47][48][49] and adjusted for both procedure difficulty and surgeon skill. 50 We hypothesized that there would be no difference in digit survival, complication rates, and surgery duration between daytime and overnight digit replantations.…”