The sleepy surgeon: does night-time surgery for trauma affect mortality outcomes?

Area of Science:

• Trauma Surgery
• Surgical Outcomes
• Patient Safety

Background:

• Sleepiness and fatigue are known to negatively impact surgical outcomes.
• The association between the timing of surgery and patient outcomes requires further investigation.

Purpose of the Study:

• To determine if nighttime trauma surgery is associated with increased mortality.
• To compare hospital mortality rates between patients operated on during off-hours versus standard daytime hours.

Main Methods:

• Analysis of adult patients undergoing exploratory laparotomy from the National Trauma Data Bank (2007-2010).
• Comparison of hospital mortality between midnight-6 am and 7 am-5 pm surgical groups using multivariate logistic regression.
• Calculation of standardized mortality ratios for each hour of the 24-hour period.

Main Results:

• Approximately 16,096 patients underwent nighttime surgery and 15,109 underwent daytime surgery.
• No significant difference in risk-adjusted mortality was observed between nighttime and daytime surgery groups (OR .97, 95% CI .893-1.058).
• Hourly variations in mortality rates were identified throughout the 24-hour cycle.

Conclusions:

• Nighttime trauma surgery does not appear to increase risk-adjusted mortality compared to daytime surgery.
• The timing of surgery within the 24-hour period may influence outcomes, warranting further hourly analysis.