Out-of-hours maxillofacial trauma surgery: a risk factor for complications?

Recent literature from general and orthopaedic surgery as well as anaesthetic viewpoints has identified that operations performed outside normal work hours pose potential risks for both patients and healthcare workers. This is in contrast to the increasing pressure for 24h surgical availability for the public and the desire to reduce waiting times for patients. Further, there is evidence of the effects of fatigue on reducing performance. The authors aim to compare outcomes of maxillofacial trauma surgery performed in and out of normal work hours. Retrospective analysis was carried out on all maxillofacial trauma surgery under general anaesthesia at a tertiary referral hospital over a 14-month period. Outcomes of patient mortality, injury severity, patient demographics and operation duration were analysed with reference to two groups: in-hours (0800-1700 Monday to Friday) and out-of-hours (1700-0800 Monday to Friday as well as all operations performed Saturday and Sunday). 134 patients/procedures met the inclusion criteria, 53 out-of-hours and 81 in-hours. A statistically significant (p=0.05) higher complication rate (13%) was found in the out-of-hours cases compared to the in-hours cases (4%). The potential implications for this result on the need for increased availability of dedicated in-hours maxillofacial trauma operating lists at major hospitals are discussed.