Nighttime Surgical Procedures Entail More Complications

Patients who enter surgery between 21:00 and 07:00 are at an increased risk of developing morbidity, according to a new study.

Researchers at the University of Michigan (U-M; Ann Arbor, USA) conducted a retrospective cohort study involving 15,807 patients who underwent neurological surgery between January 1, 2007, and August 1, 2014, in order to examine the association between surgery start time (SST) and operative morbidity. In all, 785 complications were identified through self-reported morbidity and mortality reports, which were created by U-M faculty and resident neurosurgeons.

The results showed that the odds of a complication were increased by more than 50% for procedures with start times between 9 pm and 7 am; when accounting for the length of the surgery, the odds of a complication were even greater for later time periods. The only statistically significant factor identified that could predict complication severity was if the operation was an emergency, as compared to elective surgery. Analysis revealed that the average age of the patient population varied across the surgical day, with higher ages earlier in the day, and lower ages later in the day. The study was published on October 13, 2017, in Neurosurgery.

“We need to continue to study this relationship as we aim to minimize surgery related complications. Could it mean that health systems need to invest more, with respect to increasing the number of surgical teams and operating rooms, to allow for greater proportion of surgeries to be performed during day hours, and that urgent cases should be stabilized and performed during day hours?” asked senior author Aditya Pandey, MD, of the department of Neurosurgery. “These are important questions that must be raised as we continue to solidify the relationship between surgical start time and surgical complications.”

Previous studies have documented the relationship between surgical and medical management of diseases at night leading to worse outcome, particularly in patients undergoing coronary angioplasty, orthopedic surgery, transplant surgery, colorectal surgery, and cardiac arrest patients.

Related Links:
University of Michigan