Does the time of day in orthopedic trauma surgery affect mortality and complication rates?
Time of surgery, Complications, Mortality, Trauma surgery
Journal
Patient safety in surgery
ISSN: 1754-9493
Titre abrégé: Patient Saf Surg
Pays: England
ID NLM: 101319176
Informations de publication
Date de publication:
2019
2019
Historique:
received:
22
11
2018
accepted:
21
01
2019
entrez:
16
2
2019
pubmed:
16
2
2019
medline:
16
2
2019
Statut:
epublish
Résumé
Orthopedic trauma surgery has multiple, both patient-based and surgeon-based risk factors. Evaluating and modifying certain patient safety factors could mitigate some of these risks. This study investigates the influence that the time of day of surgery has on mortality and complication rates. This study evaluates whether the time of day of orthopedic trauma surgery influences complication or mortality rates. A prospective Swiss surgical database developed as a nationwide quality assurance project was reviewed retrospectively. All patients with trauma-coded diagnoses that were surgically treated in Swiss hospitals between 2004 and 2014 were evaluated. Surgery times were stratified into morning, afternoon, evening and night. The primary outcomes were in-hospital mortality and complication rates. Co-factors were sought in bivariate and multivariable analysis. Of 31,692 patients, 13,969 (44.3%) were operated in the morning, 12,696 (40.3%) in the afternoon, 4,331 (13.7%) in the evening, and 550 (1.7%) at night. Mortality rates were significantly higher in nighttime (2.4%, OR 1.26, This study observed higher complication and mortality rates for surgery performed after-hours, which correlates with other recent studies. Surgeon fatigue is a potential contributing factor for these increased risks. Other potential factors include surgeon experience, surgery type, and the potential for more severe or emergent injuries occurring after-hours.
Sections du résumé
BACKGROUND
BACKGROUND
Orthopedic trauma surgery has multiple, both patient-based and surgeon-based risk factors. Evaluating and modifying certain patient safety factors could mitigate some of these risks. This study investigates the influence that the time of day of surgery has on mortality and complication rates.
QUESTION/PURPOSE
OBJECTIVE
This study evaluates whether the time of day of orthopedic trauma surgery influences complication or mortality rates.
PATIENTS AND METHODS
METHODS
A prospective Swiss surgical database developed as a nationwide quality assurance project was reviewed retrospectively. All patients with trauma-coded diagnoses that were surgically treated in Swiss hospitals between 2004 and 2014 were evaluated. Surgery times were stratified into morning, afternoon, evening and night. The primary outcomes were in-hospital mortality and complication rates. Co-factors were sought in bivariate and multivariable analysis.
RESULTS
RESULTS
Of 31,692 patients, 13,969 (44.3%) were operated in the morning, 12,696 (40.3%) in the afternoon, 4,331 (13.7%) in the evening, and 550 (1.7%) at night. Mortality rates were significantly higher in nighttime (2.4%, OR 1.26,
CONCLUSION
CONCLUSIONS
This study observed higher complication and mortality rates for surgery performed after-hours, which correlates with other recent studies. Surgeon fatigue is a potential contributing factor for these increased risks. Other potential factors include surgeon experience, surgery type, and the potential for more severe or emergent injuries occurring after-hours.
Identifiants
pubmed: 30766615
doi: 10.1186/s13037-019-0186-4
pii: 186
pmc: PMC6362600
doi:
Types de publication
Journal Article
Langues
eng
Pagination
8Déclaration de conflit d'intérêts
The data was gathered from an anonymous national database. It was generated from a quality management initiative and the local ethics committee (Kantonale Ethik Kommission, KEK, Zurich) waived the necessity of ethical approval to conduct this study.Not applicableThe authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Références
J Trauma. 2001 Jul;51(1):10-6
pubmed: 11468457
BMJ. 2001 Nov 24;323(7323):1222-3
pubmed: 11719413
Occup Med (Lond). 2004 Dec;54(8):556-63
pubmed: 15385648
Obstet Gynecol. 2005 Aug;106(2):352-8
pubmed: 16055587
Injury. 2007 Feb;38(2):137-46
pubmed: 16950263
Ann Surg. 2006 Oct;244(4):498-504
pubmed: 16998358
J Am Coll Surg. 2006 Dec;203(6):865-77
pubmed: 17116555
Ann Surg. 2007 Sep;246(3):456-62; discussion 463-5
pubmed: 17717449
Am J Surg. 2008 Feb;195(2):195-204
pubmed: 18194679
JAMA. 2008 Feb 20;299(7):785-92
pubmed: 18285590
Transplant Proc. 2008 Jun;40(5):1341-4
pubmed: 18589101
Am J Surg. 2008 Dec;196(6):813-9; discussion 819-20
pubmed: 19095094
Int J Colorectal Dis. 2009 Jul;24(7):789-95
pubmed: 19301016
JACC Cardiovasc Interv. 2008 Dec;1(6):681-8
pubmed: 19463384
J Bone Joint Surg Am. 2009 Sep;91(9):2067-72
pubmed: 19723981
J Am Acad Orthop Surg. 2009 Sep;17(9):541-9
pubmed: 19726738
J Trauma. 2010 Jan;68(1):19-22
pubmed: 20065752
Chest. 2010 Jul;138(1):68-75
pubmed: 20418364
J Trauma. 2011 Aug;71(2):447-53; discussion 453
pubmed: 21825947
N Engl J Med. 2012 May 31;366(22):2093-101
pubmed: 22612639
Swiss Med Wkly. 2012 Jul 19;142:w13617
pubmed: 22815136
Int J Surg. 2013;11(9):923-5
pubmed: 23872033
Geriatr Orthop Surg Rehabil. 2013 Dec;4(4):109-16
pubmed: 24600531
Clin Transl Sci. 2014 Aug;7(4):342-6
pubmed: 25043853
Injury. 2014 Oct;45 Suppl 3:S93-9
pubmed: 25284243
Ann Thorac Surg. 2015 Nov;100(5):1653-8; discussion 1658-9
pubmed: 26209491
Spine J. 2017 Jun;17(6):837-844
pubmed: 28108403
Anaesthesia. 2017 Aug;72(8):961-966
pubmed: 28585391
Diabetes Metab Res Rev. 2018 Feb;34(2):
pubmed: 29031012
J Surg Educ. 2018 Nov;75(6):1566-1574
pubmed: 29699929
Patient Saf Surg. 2018 Dec 14;12:33
pubmed: 30564285
Anesth Analg. 1970 Jul-Aug;49(4):564-6
pubmed: 5534668
Unfallheilkunde. 1982 Mar;85(3):111-5
pubmed: 7090085
Int Surg. 1993 Jul-Sep;78(3):266-70
pubmed: 8276556
J Am Coll Surg. 1997 Oct;185(4):315-27
pubmed: 9328380
Lancet. 1998 Oct 10;352(9135):1191
pubmed: 9777838