Surgical outcome of daytime and out-of-hours surgery for elderly patients with hip fracture

Chan, YM; Tang, Ning; Chow, Simon Kwoon‐Ho

doi:10.12809/hkmj165044

Cited by 6 publications

(7 citation statements)

References 18 publications

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“…Orthopedic trauma surgery performed during the afternoon and at night is associated with an increase in mortality [26]. However, none of the studies that specifically focused on hip fracture surgery could detect a statistically significant association between out-of-hours surgery and postoperative mortality [27][28][29][30][31][32][33][34]. A straightforward explanation for this could be a lack of statistical power, as most of these studies were only 1/100 th the size of the current study [27][28][29][30][31][32][33].…”

Section: Discussionmentioning

confidence: 68%

“…The effect of out-of-hours procedures has been previously investigated in orthopedic surgery, with conflicting results [26][27][28][29][30][31][32][33][34]. Orthopedic trauma surgery performed during the afternoon and at night is associated with an increase in mortality [26].…”

Section: Discussionmentioning

confidence: 99%

“…A large study including all orthopedic trauma was able to find an association between out-of-hours surgery and increased postoperative mortality [26]. To date, studies that specifically focused on hip fracture surgery were unable to detect a similar association [27][28][29][30][31][32][33][34]. Interpretation of these studies, however, is limited by relatively small sample populations [27][28][29][30][31][32][33].…”

Section: Introductionmentioning

confidence: 99%

“…To date, studies that specifically focused on hip fracture surgery were unable to detect a similar association [27][28][29][30][31][32][33][34]. Interpretation of these studies, however, is limited by relatively small sample populations [27][28][29][30][31][32][33].…”

Section: Introductionmentioning

confidence: 99%

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The consequences of out-of-hours hip fracture surgery: insights from a retrospective nationwide study

Forssten

Ismail

Borg

et al. 2021

Eur J Trauma Emerg Surg

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Purpose The study aimed to investigate the association between out-of-hours surgery and postoperative mortality in hip fracture patients. Furthermore, internal fixation and arthroplasty were compared to determine if a difference could be observed in patients operated with these techniques at different times during the day. Methods All patients above 18 of age years in Sweden who underwent hip fracture surgery between 2008 and 2017 were eligible for inclusion. Pathological fractures, non-operatively managed fractures, or cases whose time of surgery was missing were excluded. The cohort was subdivided into on-hour (08:00–17:00) and out-of-hours surgery (17:00–08:00). Poisson regression with adjustments for confounders was used to evaluate the association between out-of-hours surgery and both 30-day and 90-day postoperative mortality. Results Out-of-hours surgery was associated with a 5% increase in the risk of both 30-day [adj. IRR (95% CI) 1.05 (1.00–1.10), p = 0.040] and 90-day [adj. IRR (95% CI) 1.05 (1.01–1.09), p = 0.005] mortality after hip fracture surgery compared to on-hour surgery. There was no statistically significant association between out-of-hours surgery and postoperative mortality among patients who received an internal fixation. Arthroplasties performed out-of-hours were associated with a 13% increase in 30-day postoperative mortality [adj. IRR (95% CI) 1.13 (1.04–1.23), p = 0.005] and an 8% increase in 90-day postoperative mortality [adj. IRR (95% CI) 1.08 (1.01–1.15), p = 0.022] compared to on-hour surgery. Conclusion Out-of-hours surgical intervention is associated with an increase in both 30- and 90-day postoperative mortality among hip fracture patients who received an arthroplasty, but not among patients who underwent internal fixation.

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Section: Discussionmentioning

confidence: 68%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The consequences of out-of-hours hip fracture surgery: insights from a retrospective nationwide study

Forssten

Ismail

Borg

et al. 2021

Eur J Trauma Emerg Surg

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“…[5] Medical errors caused by fatigue or sleep deficiency were mostly occurred during surgical procedures, but their relationship with poor clinical outcomes and operative time was controversial. [1,14–17]…”

Section: Discussionmentioning

confidence: 99%

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

Guo

Liu

et al. 2019

Chinese Medical Journal

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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.

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Association Between Daytime vs Overnight Digit Replantation and Surgical Outcomes

et al. 2022

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Surgical outcome of daytime and out-of-hours surgery for elderly patients with hip fracture

Cited by 6 publications

References 18 publications

The consequences of out-of-hours hip fracture surgery: insights from a retrospective nationwide study

The consequences of out-of-hours hip fracture surgery: insights from a retrospective nationwide study

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

Association Between Daytime vs Overnight Digit Replantation and Surgical Outcomes

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