Nighttime Emergency Surgery: Higher Patient Acuity, Greater Challenges

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.