The sleepy surgeon: does night-time surgery for trauma affect mortality outcomes?

Zafar, Syed Nabeel; Libuit, Laura; Hashmi, Zain G.; Hughes, Kakra; Greene, Wendy R.; Cornwell, Edward E.; Haider, Adil H.; Fullum, Terrence M.; Tran, Daniel

doi:10.1016/j.amjsurg.2014.12.015

Cited by 33 publications

(28 citation statements)

References 22 publications

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“…For the other undifferentiated trauma patients, hemodynamically stable, increased on-scene time and total prehospital time do not increase mortality [11] . A study of the National Trauma Data Bank, investigated mortality in 15 109 patients with a laparotomy in the night time versus day time [12] . The authors found no difference in the risk-adjusted mortality rate between the two groups [12] .…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Mortality after acute trauma: Progressive decreasing rather than a trimodal distribution

Negoi

Păun

Hostiuc

et al. 2015

Journal of Acute Disease

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Objective: To characterize the pattern of mortality for major trauma patients. Methods: Retrospective study of major trauma patients admitted in a Level I trauma center, during the latest 5 years was conducted. Selection criteria included (1) injury severity score (ISS) > 16 and (2) in-hospital death. Results: There were 47 patients, with a mean age of 37.2 ± 19.9 years. The mean ISS was 37.6 ± 12.7 and the mean revised trauma score was 4.5 ± 2.2. Computed tomography scan on admission was done in 18 (38%) patients, 20% being hemodynamically unstable (P = 0.001). The diagnostic peritoneal lavage was performed in 10 (22%) cases, 23.3% being hemodynamically unstable (P > 0.05). The mean number of intraabdominal injuries was 3. The need for transfusion was 8.2 ± 6.7 units. The mean time to death was 4.9 days. Early death was secondary to hemorrhagic shock (HS) (ISS = 35.2 ± 15.9, P > 0.05, revised trauma score = 3.74 ± 2.70, P = 0.008) and multiple organ failure (ISS = 36.6 ± 14.1, P > 0.05, revised trauma score = 5.94 ± 1.34, P = 0.008) was the cause for later mortality. Combined liver and splenic injuries were found in 13 cases, with secondary death through HS in 5 and multiple system organ failure (MSOF) in 8 cases. Combined liver, splenic and kidney injuries were found in 5 cases (cause of death: HS 2 cases, MSOF 3 cases). A total of 14 patients had associated head, thorax, abdomen and extremity trauma (cause of death: cerebral trauma 6 cases, MSOF 5 cases, HS 2 cases); 5 patients had thorax and abdomen trauma (cause of death: HS 5 cases); 8 patients had thorax, abdomen and extremity trauma (cause of death: MSOF 5 cases, HS 3 cases); 3 patients had abdomen and extremity trauma (HS 2 cases). We did not find a trimodal time distribution for mortality. Conclusions: The trimodal time distribution of mortality remains a milestone in trauma education and research. Nevertheless, it must be questioned in the modern and very efficient trauma systems, but still very actual for developing trauma care systems. In conclusion, the pattern of mortality due to major trauma seems decreasing continuously with time rather than presenting high peaks of frequency at some moments.

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Section: Discussionmentioning

confidence: 99%

“…A study of the National Trauma Data Bank, investigated mortality in 15 109 patients with a laparotomy in the night time versus day time [12] . The authors found no difference in the risk-adjusted mortality rate between the two groups [12] . Strnad et al compared 40 survivors with 30 non-survivors [13] .…”

Section: Discussionmentioning

confidence: 99%

Mortality after acute trauma: Progressive decreasing rather than a trimodal distribution

Negoi

Păun

Hostiuc

et al. 2015

Journal of Acute Disease

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“…In 2015, Zafar et al concluded in their study [ 7 ] that there are no significant differences in mortalities between nighttime and daytime surgeries, based on the collected data, which may vary depending on the level of success of the trauma program. Additionally, studies [ 20 , 21 ] have shown that cholecystectomy, which is performed in about 600,000 cases annually [ 22 ] as one of most common abdominal surgeries in the United States, has similar complication rates at any time of day and may be safely performed during the day or the night.…”

Section: Discussionmentioning

confidence: 99%

“…Some studies [ 7 ] suggest that there are no significant differences in the mortality rates between daytime and nighttime surgeries. Also, there was no performance weakness for surgeons on the virtual surgery simulator after a night with less sleeping hours.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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As surgeries are performed around the clock, the time of surgery might have an impact on outcomes. Our aim is to investigate the impact of daytime and nighttime shifts on surgeons and their performance. We believe that such studies are important to enhance the quality of surgeries and their outcomes and help understand the effects of time of the day on surgeons and the surgeries they perform. A retrospective cohort study was conducted using the database from the King Abdulaziz Medical City trauma center. We selected 330 cases of patients between 2015 and 2018, who underwent a trauma intervention surgery within 24 hours after admission. Patients were aged 15 years and above who underwent 1 or more of the following trauma interventions: neurosurgery, general surgery, plastic surgery, vascular surgery, orthopedics, ophthalmology, and/or otolaryngology. We divided the work hours into 3 shifts: 8 am to 3:59 pm , 4 pm to 11:59 pm , and midnight to 7:59 am . Participants’ mean age was 31.4 (standard deviation ± 13) years. Most surgeries occurred on weekdays (68.4%). Complications were one and a half times more on weekends, with 5 complicated cases on weekends (1.55%) and 3 (0.9%) on weekdays. Half of all surgeries were performed in the morning (152 cases, 53.15%); 73 surgeries (25.5%) were performed in the evening and 61 (21.3%) were performed late at night. Surgeries performed during late-night shifts were marginally better. Complications occurred in 4 out of 152 morning surgeries (2.6%), 2 out of 73 evening surgeries (2.7%), and only 1 out of 61 late-night surgeries (1.6%). The earlier comparison scored a P -value of >.99, suggesting that patients in morning and evening surgeries were twice more likely to experience complications than late-night surgeries. This study may support previous research that there is little difference in outcomes between daytime and nighttime surgeries. The popular belief that rested physicians are better physicians requires further assessment and research.

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“…More recently, some studies have found that there were no differences in the mortality and morbidity rates between daytime and after-hours surgeries. [13][14][15][16][17] Rashid et al 13 retrospectively reviewed 220 dynamic hip screws performed for intertrochanteric fractures and found that there was no difference in the rates of wound infection, length of hospital stay, postoperative ambulation status, intraoperative blood loss, type of anesthesia, and mortality between daytime and after-hours surgeries. Switzer et al 15 performed a retrospective review on 859 with hip fractures and found that surgical time of day did not affect 30-day mortality or total number of complications.…”

Section: Discussionmentioning

confidence: 99%

After-hours elective spine deformity corrective surgery for patients with Adolescent Idiopathic Scoliosis: Is it safe?

Chiu

Chan

Chandren

et al. 2019

J Orthop Surg (Hong Kong)

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Objective: The aim of this study was to compare the outcome of after-hours electively planned Posterior Spinal Fusion surgeries for Adolescent Idiopathic Scoliosis (AIS) patients with daytime surgeries. Methods: This was a retrospective propensity score-matched study using prospectively collected data. Surgeries performed between 08:00 and 16:59 h were labeled as daytime surgeries (group 1) and surgeries performed between 17:00 and 06:00 h were labeled as after-hours surgeries (group 2). The perioperative outcome parameters were average operation time in and out, operation duration, intraoperative blood loss, blood transfusion, intraoperative hemodynamic parameters, preoperative hemoglobin, postoperative hemoglobin, and total patient-controlled anesthesia (PCA) morphine usage. Radiological variables assessed were Lenke subtypes, preoperative Cobb angle, number of fusion levels, number of screws used, postoperative Cobb angle, correction rate, side bending flexibility, side bending correction index, complications rate, and length of hospitalization. Results: Average operation time in for daytime group was 11:32 + 2:33 h versus 18:20 + 1:05 h in after-hours group. Comparing daytime surgeries with after-hours surgeries, there were no significant differences (p > 0.05) in the operation duration, intraoperative blood loss, intraoperative pH, bicarbonate, lactate, postoperative hemoglobin, hemoglobin drift, blood transfusion, postoperative Cobb angle, correction rate, side bending flexibility, side bending correction index, length of hospitalization, and complications rate. Total PCA morphine usage was significantly lesser in the after-hours group (18.2 + 15.3 mg) compared with the daytime group (24.6 + 16.6 mg; p ¼ 0.042). Conclusions: After-hours elective spine deformity corrective surgeries for healthy ambulatory patients with AIS were as safe as when they were done during daytime.

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The sleepy surgeon: does night-time surgery for trauma affect mortality outcomes?

Cited by 33 publications

References 22 publications

Mortality after acute trauma: Progressive decreasing rather than a trimodal distribution

Mortality after acute trauma: Progressive decreasing rather than a trimodal distribution

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

After-hours elective spine deformity corrective surgery for patients with Adolescent Idiopathic Scoliosis: Is it safe?

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