The impact of time of admission on major complications and mortality in patients undergoing emergency trauma surgery

Abstract

BackgroundPrevious studies have shown a relationship between time of admission to hospital and mortality rates; however, it is uncertain whether such a relationship exists for patients requiring emergency trauma surgery.Methods We included all trauma patients, except those with moderate to severe burns, who presented to a university-affiliated level 1 trauma center and underwent surgery, from 1995 until 2001 (n = 1044). We conducted univariate and multivariate analyses in which the dependent variables were in-hospital mortality and major complications, and the independent variables were the time of presentation to the trauma centre (nighttime vs. daytime, weekend vs. weekday, month of year, and year), age, sex, injury severity score, type of operative procedure, and total number of operative procedures.Results None of the factors related to time of presentation were associated with major complications or mortality. Factors predictive of increased mortality were higher ISS (odds ratio 1.07; 95% confidence interval 1.03-1.08), older age (1.04; 1.03-1.07), operations involving the cardiovascular system (1.7; 1-2.6), "miscellaneous" operative procedures (1.8; 1.1-2.9), and major complications (2.4; 1.4-4.2).Interpretation Time of presentation for emergency trauma surgery was not associated with differences in major complications or in mortality.

Short-term mortality in hip fracture patients admitted during weekends and holidays

“…A 'July effect' has been hypothesized in American studies based on influx of junior doctors rather than staff reductions, but this did not influence outcome in trauma patients. 8 Seasonal variation in outcome after hip fracture has been reported previously, with mortality peaking during winter months. 9 The present study incorporates a mixture of holiday periods during both summer and winter months and, as such, the present findings cannot be explained by a seasonal variation.…”

What Is the Safety of Nonemergent Operative Procedures Performed at Night? A Study of 10,426 Operations at an Academic Tertiary Care Hospital Using the American College of Surgeons National Surgical Quality Program Improvement Database

“…6 Outcomes in emergency trauma surgery did not differ with patient presentation between night and day. 7 Delaying surgery until daytime hours did not affect outcomes for children with acute appendicitis. 8 And better cardiovascular outcomes were reported for night-time hemodialysis patients compared with conventional dialysis patients.…”

A population based study on the night-time effect in trauma care

“…It may seem surprising that the severity of injuries was similar in the two groups because injuries are believed to be worse at night due to more severe traffic accidents24 or more acts of violence leading to more penetrating injuries 6. However, in the study that reported this latter finding, the total incidence of penetrating trauma was much higher than in our setting18 (ie, 9.5% vs 1.5%).…”

“…One study certainly included these patients9 and another one6 possibly did, although without stating it unambiguously. However, in the first study, the condition of having being transferred had an unexpected statistically significant protective effect, somewhat contrasting with established knowledge21 and possibly betraying some selection bias.…”