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

Turrentine, Florence E.; Wang, Hongkun; Young, Jeffrey S.; Calland, J. Forrest

doi:10.1097/ta.0b013e3181e49291

Cited by 34 publications

(32 citation statements)

References 22 publications

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“…(14) No difference in mortality was found in an academic setting having non-emergent surgery with evening start times when controlling for patient factors. (13, 15) Transplant patients having evening surgery have the same mortality to those performed during daytime hours. (12, 16)…”

Section: Discussionmentioning

confidence: 99%

Factors That Correlate With the Decision to Delay Extubation After Multilevel Prone Spine Surgery

Anastasian¹,

Gaudet²,

Levitt

et al. 2014

Journal of Neurosurgical Anesthesiology

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Background Multi-level spinal decompressions and fusions often require long anesthetic and operative times which may result in airway edema and prolonged post-operative intubation. Delayed extubation can lead to broncho-pulmonary infections and other complications. This study analyzed which factors correlated with the decision to delay extubation after multilevel spine surgery. Methods We reviewed the records of 289 patients having multilevel spine surgery lasting 8 hours or more in the prone position from 2006 to 2012. Variables hypothesized to affect the decision of the anesthesiologist to delay extubation at the end of the surgery were collected. These included preoperative factors (age, gender, ASA Class, history of obstructive sleep apnea, BMI, previous spine surgery, current cervical surgery, anterior in addition to posterior spine surgery, emergency surgery), and intraoperative factors (difficult intubation, number of surgical levels, case time, estimated blood loss, fluid and blood administration, attending handoff and resident handoff, and case end time). We also compared the incidence of pulmonary post-operative complications between patients extubated at the end of the case to patients who had a delayed extubation. Results 126 patients (44%) were kept intubated after multilevel spine surgery. Multiple linear regression analysis showed factors that correlated with prolonged intubation included age, ASA Class, procedure duration, extent of surgery, total crystalloid volume administered, total blood volume administered, and the case end time. Patients who had a delayed extubation had a threefold higher rate of post-operative pneumonia. Conclusions Our study finds that age, ASA class, procedure duration, extent of surgery, and total crystalloid and blood volume administered correlate with the decision to delay extubation in multilevel prone spine surgery. It also finds that the time that the case ends is an independent variable that correlates with the decision not to extubate at the end of a long multi-level spinal surgery. The incidence of post-operative pneumonia is higher in patients who had a delayed extubation after surgery.

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Section: Discussionmentioning

confidence: 99%

Factors That Correlate With the Decision to Delay Extubation After Multilevel Prone Spine Surgery

Anastasian¹,

Gaudet²,

Levitt

et al. 2014

Journal of Neurosurgical Anesthesiology

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show abstract

“…Although at least one study 15 has specifically confirmed the safety of nonemergent at-night surgery, it was not the intention of our study to look at that variable in particular. However, our finding clearly attests to the effectiveness of our ACS model in delivering excellent health care services.…”

Section: Discussionmentioning

confidence: 93%

Time and cost analysis of gallbladder surgery under the acute care surgery model

Michailidou

Kulvatunyou

Friese

et al. 2014

Journal of Trauma and Acute Care Surgery

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“…Zafar et al 16 found that trauma surgery during the night did not have an increased mortality when compared with surgery during the day. Turrentine et al 17 found that patients undergoing nonemergent general and vascular surgery procedures at night do not seem to be at an increased risk for postoperative morbidity or mortality. However, all of these studies were retrospective studies on patients who had fracture or had included patients who required emergency surgery, and none of them had matched comparable group that looked exclusively into elective major surgical procedures.…”

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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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

Cited by 34 publications

References 22 publications

Factors That Correlate With the Decision to Delay Extubation After Multilevel Prone Spine Surgery

Factors That Correlate With the Decision to Delay Extubation After Multilevel Prone Spine Surgery

Time and cost analysis of gallbladder surgery under the acute care surgery model

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

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