Nuo Yang1, Waleed Mohammad Elmatite2, Abdelrahman Elgallad3, Csaba Gajdos4, Leili Pourafkari5, Nader D Nader6. 1. Department of Anesthesiology, University at Buffalo, Buffalo, NY, USA. Electronic address: nuoyang@buffalo.edu. 2. Department of Anesthesiology, Children and Women's Hospital, Buffalo, NY, USA. Electronic address: Waleed24572@hotmail.com. 3. Department of Anesthesiology, Watertown General Hospital, Watertown, NY, USA. Electronic address: abdelrahman2000@yahoo.com. 4. Department of Surgery, University at Buffalo, Buffalo, NY, USA. Electronic address: Csaba.gajdos@va.gov. 5. Department of Anesthesiology, University at Buffalo, Buffalo, NY, USA. Electronic address: leilipou@buffalo.edu. 6. Department of Anesthesiology, University at Buffalo, Buffalo, NY, USA; Department of Surgery, University at Buffalo, Buffalo, NY, USA; University at Buffalo-Anesthesiology, 77 Goodell Street, Suite # 550, Buffalo, NY 14203, USA. Electronic address: nnader@buffalo.edu.
Abstract
BACKGROUND: It has been investigated in multiple subspecialties that surgery timing may have an impact on patient outcomes, yet no definitive evidence is reached. OBJECTIVES: To analyze current literature on this topic and investigate whether day versus after-hours surgery may have an effect on postoperative outcomes. DATA SOURCES: MEDLINE, EMBASE and Cochrane Library. STUDY ELIGIBILITY CRITERIA: Studies reporting on the surgery timing as well as postoperative mortality and morbidity were included. PARTICIPANTS AND INTERVENTIONS: There were 119,213 and 46,196 surgery cases that occurred during daytime and after-hours shifts, respectively. STUDY APPRAISAL AND SYNTHESIS METHODS: Thirteen studies (12 retrospective case controls and 1 prospective study) published in English between February 2003 and May 2018 were scrutinized by two reviewers. The odds ratio (OR) for each clinical outcome data was presented with a 95% confidence interval (CI). Pooled estimates of effects were calculated using random-effect models. RESULTS: Among the included studies, 10 reported morbidities and 10 reported death rates. The pooled OR was 0.67 (95% CI: 0.51-0.89; p = 0.005) for postoperative mortality and 0.71 (95% CI: 0.53-0.94; p = 0.02) for overall postoperative complications in patients who underwent daytime versus after-hours surgery. CONCLUSION: After-hours surgery was associated with significantly increased postoperative mortality and morbidity, which might be related to state of urgency, availability of resource and/or fatigue factor of the personnel. Published by Elsevier Inc.
BACKGROUND: It has been investigated in multiple subspecialties that surgery timing may have an impact on patient outcomes, yet no definitive evidence is reached. OBJECTIVES: To analyze current literature on this topic and investigate whether day versus after-hours surgery may have an effect on postoperative outcomes. DATA SOURCES: MEDLINE, EMBASE and Cochrane Library. STUDY ELIGIBILITY CRITERIA: Studies reporting on the surgery timing as well as postoperative mortality and morbidity were included. PARTICIPANTS AND INTERVENTIONS: There were 119,213 and 46,196 surgery cases that occurred during daytime and after-hours shifts, respectively. STUDY APPRAISAL AND SYNTHESIS METHODS: Thirteen studies (12 retrospective case controls and 1 prospective study) published in English between February 2003 and May 2018 were scrutinized by two reviewers. The odds ratio (OR) for each clinical outcome data was presented with a 95% confidence interval (CI). Pooled estimates of effects were calculated using random-effect models. RESULTS: Among the included studies, 10 reported morbidities and 10 reported death rates. The pooled OR was 0.67 (95% CI: 0.51-0.89; p = 0.005) for postoperative mortality and 0.71 (95% CI: 0.53-0.94; p = 0.02) for overall postoperative complications in patients who underwent daytime versus after-hours surgery. CONCLUSION: After-hours surgery was associated with significantly increased postoperative mortality and morbidity, which might be related to state of urgency, availability of resource and/or fatigue factor of the personnel. Published by Elsevier Inc.
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