Impact of nighttime procedures on outcomes after liver transplantation

Abstract

Background Sleep deprivation is a well-known risk factor for the performance of medical professionals. Solid organ transplantation (especially orthotopic liver transplantation (oLT)) appears to be vulnerable since it combines technically challenging operative procedures with an often unpredictable start time, frequently during the night. Aim of this study was to analyze whether night time oLT has an impact on one-year graft and patient survival. Material and methods Deceased donor oLTs between 2006 and 2017 were retrospectively analyzed and stratified for recipients with a start time at day (8 a.m. and 6 p.m.) or at night (6 p.m. to 8 a.m.). We examined donor as well as recipient demographics and primary outcome measure was one-year patient and graft survival. Results 350 oLTs were conducted in the study period, 154 (44%) during daytime and 196 (56%) during nighttime. Donor and recipient variables were comparable. One-year patient survival (daytime 75.3% vs nighttime 76.5%, p = 0.85) as well as graft survival (daytime 69.5% vs nighttime 73.5%, p = 0.46) were similar between the two groups. Frequencies of reoperation (daytime 53.2% vs nighttime 55.1%, p = 0.74) were also not significantly different. Conclusion Our retrospective single center data derived from a German transplant center within the Eurotransplant region provides evidence that oLT is a safe procedure irrespective of the starting time. Our data demonstrate that compared to daytime surgery nighttime liver transplantation is not associated with a greater risk of surgical complications. In addition, one-year graft and patient survival do not display inferior results in patients undergoing nighttime transplantation.

Totally implantable venous access port insertion via open Seldinger approach of the internal jugular vein—a retrospective risk stratification of 500 consecutive patients

“…In addition, it was not analyzed whether TIVAP implantation was routinely scheduled or conduced as an urgent procedure to allow for rapid start of chemotherapy in critical cases. Although this might be a minor bias, time of operation has been proven to affect outcomes of surgical procedures [21][22][23].…”

Effect of Time (Season, Surgical Starting Time, Waiting Time) on Patients with Gastric Cancer

“…[10][11][12] Similarly, surgery during the daytime had fewer complications than at nighttime. 20,21 Workload and fatigue may be major contributors to these outcomes. China is a populous country and has the largest number of gastric cancer patients worldwide.…”

The Actual Operative Costs of Liver Transplantation and Normothermic Machine Perfusion in a Canadian Setting

“…Traditionally, many transplantations occur during night-time hours [20]. Although studies have shown that patient outcomes are not impacted by night-time transplants, over time, the combination of night-time operating and a busy transplantation service can lead to transplant team burnout and potentially a lack of personnel available for call coverage [20][21][22][23][24]. The introduction of NMP has enabled a shift of transplantation from night-time to daytime hours, as NMP can be run overnight [7,25].…”

“…In addition to the potential clinical benefits of NMP, the surgical teams may also benefit. Traditionally, many transplantations occur during night-time hours [ 20 ]. Although studies have shown that patient outcomes are not impacted by night-time transplants, over time, the combination of night-time operating and a busy transplantation service can lead to transplant team burnout and potentially a lack of personnel available for call coverage [ 20 – 24 ].…”