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Nighttime Emergency Surgery: Higher Patient Acuity, Greater Challenges.

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Emergency general surgery outcomes may differ by time of day. Nighttime surgery is linked to higher damage control laparotomy (DCL) use and mortality, likely due to increased patient acuity and instability.

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Area of Science:

  • Surgery
  • Emergency Medicine
  • Critical Care Medicine

Background:

  • Patient outcomes in emergency general surgery (EGS) may be influenced by the time of day.
  • Prior studies suggest worse outcomes for nighttime procedures.

Purpose of the Study:

  • To examine differences in damage control laparotomy (DCL) utilization and mortality between daytime and nighttime emergent laparotomies.
  • To evaluate the effect of nighttime presentation on DCL and mortality.

Main Methods:

  • Retrospective cohort study from January 2015 to December 2023.
  • Included patients undergoing emergent exploratory laparotomy during daytime (7:00 AM-5:00 PM) or nighttime (5:00 PM-7:00 AM).
  • Primary outcome: all-cause inpatient mortality. Secondary outcomes: DCL rates, complications, critical care metrics, and hospital length of stay.

Main Results:

  • Among 1279 patients, nighttime patients (44%) had higher ASA class 5 proportions and greater intraoperative vasopressor use.
  • Damage control laparotomy was more frequent at night (50.4% vs 38.7%).
  • Mortality was higher for nighttime cases (18.3% vs 14.1%), independent of DCL. Nighttime surgery was associated with increased ICU admission, mechanical ventilation, and vasopressor use.

Conclusions:

  • Nighttime surgery in EGS is associated with higher DCL utilization and mortality compared to daytime surgery.
  • These findings are likely due to higher patient acuity and hemodynamic instability at night.
  • Further research may explore strategies to mitigate nighttime disparities in EGS outcomes.