Is Nighttime Laparoscopic General Surgery Under General Anesthesia Safe?

Koltka, Ahmet; İlhan, Mehmet; Ali, Achmet; Gök, Ali Fuat Kaan; Sivrikoz, Nükhet; Yanar, Teoman Hakan; Günay, Mustafa Kayıhan; Ertekın, Cemalettın

doi:10.5505/tjtes.2017.95079

Cited by 8 publications

(12 citation statements)

References 17 publications

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“…Night-time surgery has often been associated to a higher morbidity or mortality rate, previous studies confirming these hypotheses. 1,2 However, the primary outcome of our study confirmed the results of several other studies that contradicted the correlation between night-time surgery and worse clinical outcomes, such as postoperative complications or graft failure. Kienzl-Wagner et al 12 showed no differences in postoperative complications, and even less acute rejection (22.6% vs. 18.3% in night-time graft recipients, p = .15) for night-time KT.…”

Section: Discussionsupporting

confidence: 88%

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

Treacy

Barthe

Bentellis

et al. 2021

Immunity Inflam & Disease

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Introduction: Various surgical centers tend to postpone a kidney transplantation (KT) to the following morning than to operate at night-time. The objective of our study was to assess whether there was any difference between daytime and night-time renal transplantation in our institution. Method: This study is a retrospective monocentric study including all the KTs that were performed between 2012 and 2013 by transplant expert surgeons in our institution. Clavien-Dindo (CD) complications were classified according to 7 variables going from 1 to 5. Time before postgraft diuresis and delayed graft function (DGF) were also analyzed. Two groups of patients were formed according to threshold value of incision time (6.30 p.m.). Data comparison were performed using the Kruskal-Wallis nonparametric test. Results: A total of 179 patients were included. Median follow-up was 24 months. Cold ischemia time was longer in the night-time transplantation (1082 vs. 807 min, p < .001), but rewarming time was shorter (47.24 vs. 52.15 min, p = .628). No statistically significant differences were observed between the two groups using the Kruskal-Wallis method for CD complications (Qobs: 0.076; p = .735). CD complications proportion was similar, with a majority of grade II complications (72.7% daytime group vs. 75.4% night-time group (p = .735). DGF (19 patients for daytime group vs. 13 patients for night-time group, p = .359) and time before postgraft diuresis (4.65 days daytime group vs. 5.27 days night-time group, p = .422) were similar between both groups. Multivariate analysis did not show significant predictors of CD complications Grade 3 and more.

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Section: Discussionsupporting

confidence: 88%

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

Treacy

Barthe

Bentellis

et al. 2021

Immunity Inflam & Disease

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“…Multiple stud ies have examined the impact of afterhours operating on appendectomy and cholecystectomy outcomes, with mixed results. [13][14][15][16][17][18] Delay to operative intervention has been difficult to study because of the diversity of disease processes, severity of presentation and variable comorbidities in EGS patients.…”

mentioning

confidence: 99%

Operative timing is associated with increased morbidity and mortality in patients undergoing emergency general surgery: a multisite study of emergency general services in a single academic network

Meschino

Giles

Rice

et al. 2020

CJS

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Background: Despite the widespread implementation of the acute care surgery (ACS) model, limited access to operating room time represents a barrier to the optimal delivery of emergency general surgery (EGS) care. The objective of this study was to describe the effect of operative timing on outcomes in EGS in a network of teaching hospitals. Methods: We conducted a retrospective review of EGS operations performed at 3 teaching hospitals in a single academic network. Time of operation was categorized as daytime (8 am to 5 pm), after hours (5 pm to 11 pm) or overnight (11 pm to 8 am). Time to operation was calculated as the interval from admission to operative start time and categorized as less than 24 hours, 24-72 hours and greater than 72 hours. Results: After we excluded nonindex cases, trauma cases and cases occurring more than 5 days after admission, 1505 EGS cases were included. We found that 39.0% of opera tions were performed in the daytime, 46.3% after hours and 14.8% overnight. In terms of time to operation, 52.3% of operations were performed within 24 hours of admission, 33.4% in 24-72 hours and 14.3% in more than 72 hours. The overall complication rate was 20.6% (310 patients) and the overall mortality rate was 3.8% (57 patients). After multivariable analysis, time to operation more than 72 hours after admission was inde pendently associated with increased odds of morbidity (odds ratio [OR] 1.64, 95% con fidence interval [CI] 1.09-2.47), while overnight operating was associated with increased odds of death (OR 3.15, 95% CI 1.29-7.70). Conclusion: Increasing time from admission to operation and overnight operating were associated with greater morbidity and mortality, respectively, for EGS patients. Strat egies to provide timely access to the operating room should be considered to optimize care in an ACS model. Contexte : Même si le modèle de chirurgie en soins actifs (CSA) est largement répandu, l'accès limité aux blocs opératoires représente un obstacle à la chirurgie générale chez les patients des services d'urgence (CGSU). L'objectif de cette étude était de décrire l'effet du moment de l'intervention sur l'issue des CGSU dans un réseau d'hôpitaux universitaires. Méthodes : Nous avons procédé à une revue des CGSU effectuées dans 3 hôpitaux d'enseignement d'un réseau universitaire. Le moment opératoire était catégorisé selon que les interventions étaient effectuées le jour (8 h 00 à 17 h 00), le soir (17 h 00 à 23 h 00) ou la nuit (23 h 00 à 8 h 00). Le délai opératoire représentait l'intervalle entre l'admission et le début de l'intervention et était réparti selon les catégories suivantes : moins de 24 heures, de 24 à 72 heures et plus de 72 heures. Résultats : Après exclusion des cas non index, des cas de traumatologie et des cas sur venus plus de 5 jours après l'admission, 1505 CGSU ont été incluses. Nous avons constaté que 39,0 % des interventions avaient été effectuées le jour, 46,3 % le soir et 14,8 % la nuit. Pour ce qui est du délai opératoire, 52,3 % des interventions ont été effectuées dans les...

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“…Recent evidence has shown that night-time surgery is associated with increased risk of intraoperative complication. 11,12 The improvement in these efficiency outcomes can be attributed to the streamlined work processes and improved communication between disciplines. Most studies on acute care surgeries also reported similar benefits.…”

Section: Discussionmentioning

confidence: 99%

“…With a greater proportion of daytime surgeries, the presumption is that there could be fewer mistakes as staff are more alert and vigilant. Recent evidence has shown that night‐time surgery is associated with increased risk of intraoperative complication 11,12 …”

Section: Discussionmentioning

confidence: 99%

Impact of a dedicated emergency surgical service on appendicitis outcomes

Goh

Cheok

Lim

et al. 2020

Acute Medicine & Surgery

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Aim: The Emergency Surgery and Trauma (ESAT) team is a dedicated consultant-led service to streamline the emergency surgical workload in Singapore. As acute appendicitis is one of the most common acute surgical conditions, we aim to compare outcomes of patients with appendicitis in the ESAT model as compared to the traditional on-call model. Methods: A retrospective review of patients admitted to Khoo Teck Puat Hospital, Singapore, with acute appendicitis between two periods: May-October 2014 (6 months pre-ESAT) versus January-June 2017 (post-ESAT). Patient demographics, operative details, efficiency, clinical outcomes, and hospital bill savings were evaluated. Results: There were 192 patients in the pre-ESAT period and 179 patients in the post-ESAT period. Patient demographics and comorbidities were comparable (P > 0.05). Time from emergency department referral to surgical review was significantly reduced in the ESAT period: 77.8 AE 46.9 min versus 127 AE 102 in the pre-ESAT period (P = 0.002). Time from case booking to operating theatre was significantly shorter in the ESAT period: 72.4 AE 55.2 min compared to 157.3 AE 209.1 (P < 0.01). More cases were carried out in the daytime during the ESAT period, 50.2% versus 39.1% (P = 0.029). The majority underwent laparoscopic appendectomy 156/179 (87.2%) in the ESAT period, with fewer open appendectomies 3/179 (1.7%) as compared to the pre-ESAT period (P = 0.062). There were higher intraoperative consultant supervision rates during the ESAT period, 38/166 (22.9%) as compared to 12/166 (6.7%) in the pre-ESAT period (P = 0.001). There were fewer complications (Clavien-Dindo grade II and above) in the ESAT period, 1 (0.6%) as compared to 6 (3.4%) pre-ESAT (P = 0.07). Conclusion: The ESAT service is associated with better efficiency outcomes for patients with acute appendicitis.

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Is Nighttime Laparoscopic General Surgery Under General Anesthesia Safe?

Cited by 8 publications

References 17 publications

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

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

Operative timing is associated with increased morbidity and mortality in patients undergoing emergency general surgery: a multisite study of emergency general services in a single academic network

Impact of a dedicated emergency surgical service on appendicitis outcomes

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