Analysis of the Effects of Day-Time vs. Night-Time Surgery on Renal Transplant Patient Outcomes

Abstract

Sleep deprivation and disruption of the circadian rhythms could impair individual surgical performance and decision making. For this purpose, this study identified potential confounding factors on surgical renal transplant patient outcomes during day and night. Our retrospective cohort study of 215 adult renal cadaver transplant recipients, of which 132 recipients were allocated in the “day-time” group and 83 recipients in the “night-time” group, primarily stratified the patients into two cohorts, depending on the start time. Within a 24 h operational system, “day-time” was considered as being from 8 a.m. to 8 p.m. and “night-time” from 8 p.m. to 8 a.m.. Primary outcomes examined patient and graft survival after three months and one year. Secondary outcomes included the presence of acute rejection (AR) and delayed graft function (DGF), as well as the rate of postoperative complications. In log-rank testing, “day-time” surgery was associated with a significantly higher risk of patient death (p = 0.003), whereas long-term graft survival was unaffected by the operative time of day. The mean cold ischemia time (CIT), which was 12.4 ± 5.3 h in the “night-time” group, was significantly longer compared to 10.7 ± 3.6 for those during the day (p = 0.01). We observed that “night-time” kidney recipients experienced more wound complications. From our single-centre data, we conclude that night-time kidney transplantation does not increase the risk of adverse events or predispose the patient to a worse outcome. Nevertheless, further research is required to explore the effect of fatigue on nocturnal surgical performance.

Time of day does not influence outcomes in acute type A aortic dissection: Results from the IRAD

“…3 | RESULTS (Table 1). Patients in the evening cohort were more likely to be transferred from outside centers (75% vs. 70.8%; p = .003), had shorter times from presentation to procedure (6 h [4][5][6][7][8][9][10][11][12] vs. 7 h [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21]; p = .004), and fewer known aortic aneurysms (12.1% vs. 15.0%; p = 0.011), previous dissections (3.4% vs. 4.8%; p = .040), and prior cardiac operations (9.5% vs.…”

“…[1][2][3][4] However, findings of increased surgical morbidity and mortality during evening hours are by no means universal, as some data show no difference in outcomes for surgical procedures during evening hours. [5][6][7][8][9] The relevance to the public health community for maintaining patient safety during surgery, despite evening operative hours, cannot be overstated. It was estimated by the Institute of Medicine that in any given year, 98,000 patients die as a results of hospital errors made by staff.…”

“…Multiple studies have shown inferior outcomes for surgical procedures during evening hours 1–4 . However, findings of increased surgical morbidity and mortality during evening hours are by no means universal, as some data show no difference in outcomes for surgical procedures during evening hours 5–9 …”

Will surgeries performed at night lead to worse outcomes? Findings from a trauma center in Riyadh

“…[ 33 ] In addition, in a paper [ 34 ] that surveyed 27,305 cardiac surgery patients between 2010 and 2017 to compare morning and afternoon cardiac surgeries (procedures that included coronary artery bypass graft with internal mammary, or thoracic artery and vein or radial artery bypass) in regard to surgical site infections and mortality, the conclusion was that current evidence is not enough to favor afternoon cardiac surgeries, and that increased rates of morning myocardial infarction were not associated with an impact on the 1-year deep surgical site infections or mortality rate. Furthermore, there are a number of studies [ 35 – 37 ] of different transplant surgical procedures that have concluded that there is no higher risk, no poorer outcomes, and no adverse complications during nighttime surgeries compared to daytime.…”

A model-based validation study of postoperative complications with considerations on operative timing

“…For example, operative timing in emergency general surgery was associated with increased postoperative complications (14) and the operative start time of cardiac surgery affected i n t r a o p e r a t i v e t r a n s f u s i o n r a t e s ( 1 5 ) . H o w e v e r, postoperative complications and overall survival rates did not vary with start time in the performance of radical gastrectomy (16), hip fracture fixation (17), renal transplantation (18), and liver resection (19). The outcome of minimal invasive endometrial cancer surgery and laparoscopic sacrocolpopexy (20) also had no association with operative start time (21) and although afternoon surgeries were found to be associated with increased levels of cortisol and inflammatory cytokines [interleukin (IL)-6, IL-8] (22), no conclusion of correlation between operation time and postoperative infectious complications (23).…”