Impact of nighttime and weekends on outcomes of emergency trauma patients

Hirose, Tomoya; Kitamura, Tetsuhisa; Katayama, Yusuke; Sado, Junya; Matsuyama, Tasuku; Kiyohara, Kosuke; Takahashi, Hiroki; Tachino, Jotaro; Nakagawa, Yuko; Mizushima, Yasuaki; Shimazu, Takeshi

doi:10.1097/md.0000000000018687

Cited by 26 publications

(21 citation statements)

References 24 publications

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“…Concerning neurosurgical procedures, Desai et al reported an increased morbidity and mortality rate among pediatric neurosurgical emergencies admitted during out-of-office hours [10]. Hirose et al found that in-hospital mortality of emergency trauma patients was significantly higher during nighttime, however, there was no difference regarding weekdays and weekends [19]. In contrast, Rumalla et al found no association between weekend admission and mortality among traumatic subdural hematoma patients [35].…”

Section: Discussionmentioning

confidence: 99%

Impact of the weekend effect on outcome after microsurgical clipping of ruptured intracranial aneurysms

et al. 2021

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Background The “weekend effect” describes the assumption that weekend and/or on-call duty admission of emergency patients is associated with increased morbidity and mortality rates. For aneurysmal subarachnoid hemorrhage, we investigated, whether presentation out of regular working hours and microsurgical clipping at nighttime correlates with worse patient outcome. Methods This is a retrospective review of consecutive patients that underwent microsurgical clipping of an acutely ruptured aneurysm at our institution between 2010 and 2019. Patients admitted during (1) regular working hours (Monday–Friday, 08:00–17:59) and (2) on-call duty and microsurgical clipping performed during (a) daytime (Monday–Sunday, 08:00–17:59) and (b) nighttime were compared regarding the following outcome parameters: operation time, treatment-related complications, vasospasm, functional outcome, and angiographic results. Results Among 157 enrolled patients, 104 patients (66.2%) were admitted during on-call duty and 48 operations (30.6%) were performed at nighttime. Admission out of regular hours did not affect cerebral infarction (p = 0.545), mortality (p = 0.343), functional outcome (p = 0.178), and aneurysm occlusion (p = 0.689). Microsurgical clipping at nighttime carried higher odds of unfavorable outcome at discharge (OR: 2.3, 95%CI: 1.0–5.1, p = 0.039); however, there were no significant differences regarding the remaining outcome parameters. After multivariable adjustment, clipping at nighttime did not remain as independent prognosticator of short-term outcome (OR: 2.1, 95%CI: 0.7–6.2, p = 0.169). Conclusions Admission out of regular working hours and clipping at nighttime were not independently associated with poor outcome. The adherence to standardized treatment protocols might mitigate the “weekend effect.”

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Section: Discussionmentioning

confidence: 99%

Impact of the weekend effect on outcome after microsurgical clipping of ruptured intracranial aneurysms

et al. 2021

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“…The “weekend effect” refers to the phenomenon in which patients admitted during weekends may have more fatal outcomes than those admitted during the weekdays 7 , 8 . Poor performances in hospitals are considered a reason for this effect.…”

Section: Discussionmentioning

confidence: 99%

Survival outcomes after traumatic brain injury during national academic meeting days in Japan

Hosomi

Kitamura

Sobue

et al. 2021

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Surgeons and medical staff attend academic meetings several times a year. However, there is insufficient evidence on the influence of the “meeting effect” on traumatic brain injury (TBI) treatments and outcomes. Using the Japan Trauma Data Bank, we analyzed the data of TBI patients admitted to the hospital from 2004 to 2018 during the national academic meeting days of the Japanese Association for Acute Medicine, the Japanese Society of Intensive Care Medicine, the Japanese Association for the surgery of trauma, the Japan Society of Neurotraumatology and the Japan Neurosurgical Society. The data of these patients were compared with those of TBI patients admitted 1 week before and after the meetings. The primary outcome was in-hospital death. We included 7320 patients in our analyses, with 5139 and 2181 patients admitted during the non-meeting and meeting days, respectively; their in-hospital mortality rates were 15.7% and 14.5%, respectively. No significant differences in in-hospital mortality were found (adjusted odds ratio, 0.93; 95% confidence interval, 0.78–1.11). In addition, there were no significant differences in in-hospital mortality during the meeting and non-meeting days by the type of national meeting. In Japan, it is acceptable for medical professionals involved in TBI treatments to attend national academic meetings without impacting the outcomes of TBI patients.

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“…Research staff listed the following possible factors for this conclusion: age-related effect of sleep loss, difference in responsibilities between staff and fellows in the daytime, and supervision of nighttime fellows. Moreover, a nationwide study based on the Japan Trauma Data Bank [ 45 ] from 2004 to 2015 divided the day into 2 shifts (daytime, 9 am to 4:59 pm , and nighttime, 5 pm to 8:59 am ) and found a significant daytime decrease in deaths among emergency trauma patients, both in the emergency room and at hospital discharge; there was no association between weekday/weekend and outcomes. In addition, a systematic review [ 46 ] of 40 observational studies that included about 3 million patients concluded that postoperative risk of mortality is associated more with surgery performed at night/after-hours than surgery performed during the day.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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As surgeries are performed around the clock, the time of surgery might have an impact on outcomes. Our aim is to investigate the impact of daytime and nighttime shifts on surgeons and their performance. We believe that such studies are important to enhance the quality of surgeries and their outcomes and help understand the effects of time of the day on surgeons and the surgeries they perform. A retrospective cohort study was conducted using the database from the King Abdulaziz Medical City trauma center. We selected 330 cases of patients between 2015 and 2018, who underwent a trauma intervention surgery within 24 hours after admission. Patients were aged 15 years and above who underwent 1 or more of the following trauma interventions: neurosurgery, general surgery, plastic surgery, vascular surgery, orthopedics, ophthalmology, and/or otolaryngology. We divided the work hours into 3 shifts: 8 am to 3:59 pm , 4 pm to 11:59 pm , and midnight to 7:59 am . Participants’ mean age was 31.4 (standard deviation ± 13) years. Most surgeries occurred on weekdays (68.4%). Complications were one and a half times more on weekends, with 5 complicated cases on weekends (1.55%) and 3 (0.9%) on weekdays. Half of all surgeries were performed in the morning (152 cases, 53.15%); 73 surgeries (25.5%) were performed in the evening and 61 (21.3%) were performed late at night. Surgeries performed during late-night shifts were marginally better. Complications occurred in 4 out of 152 morning surgeries (2.6%), 2 out of 73 evening surgeries (2.7%), and only 1 out of 61 late-night surgeries (1.6%). The earlier comparison scored a P -value of >.99, suggesting that patients in morning and evening surgeries were twice more likely to experience complications than late-night surgeries. This study may support previous research that there is little difference in outcomes between daytime and nighttime surgeries. The popular belief that rested physicians are better physicians requires further assessment and research.

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Impact of nighttime and weekends on outcomes of emergency trauma patients

Cited by 26 publications

References 24 publications

Impact of the weekend effect on outcome after microsurgical clipping of ruptured intracranial aneurysms

Impact of the weekend effect on outcome after microsurgical clipping of ruptured intracranial aneurysms

Survival outcomes after traumatic brain injury during national academic meeting days in Japan

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

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