Earlier Surgery May Reduce Anesthesia Problems

Scheduling surgery earlier in the day may help prevent unexpected problems related to anesthesia, including added pain and postoperative nausea and vomiting, according to a new study.

Researchers at the Duke University Medical Center (Durham, NC, USA) analyzed more than 90,000 surgeries performed at the hospital between the years 2000-2004. The researchers analyzed a database maintained by the hospital that contains a record of each surgical patient's course of treatment from hospital admission to discharge, and found that patients whose surgeries began around 4 p.m. were about four times more likely to request pain medication than those whose surgeries started around 9 a.m. Looking for the cause of this finding, they divided the problems encountered into three categories: error, harm, and other adverse events.

The 31 incidents placed in the error category included improper dosing of patients with anesthetic agents. The researchers deemed 667 incidents as "harmful,” ranging from prolonged sedation to an infected wound, with postoperative nausea and vomiting accounting for 35% of these incidents. There were 1,995 other incidents,” which included potentially dangerous changes in blood pressure and problems with operating room equipment. The study identified several possible reasons why there were more problems later in the day, including tired health care workers and swings in people's natural ups and downs during the day. Doctors arriving late for surgery, a lack of transporters available to move patients, and delays in completing test results were also possible sources of late-day problems. The study was published in the August 2006 issue of the journal Quality & Safety in Health Care.

"On the positive side we didn't find anything that showed people were being hurt badly by this,” said lead author Dr. Melanie Wright, a human factors specialist at Duke University. "But it points to something we can look at more closely: can we improve quality care?”



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