Neurosurgery at Night May Hold Greater Risk for Complications

Neurosurgical procedures performed overnight (between 9:00 p.m. and 7:00 a.m.) are tied to a greater risk of patient complications than those conducted during the day, according to a new study published in the journal Neurosurgery.

Neurosurgical procedures are necessary at all times of day. Prior research has shown a link between surgical and medical management of diseases at night leading to poorer outcomes. This has been particularly evident in patients undergoing coronary angioplasty, orthopedic surgery, transplant surgery, colorectal surgery, and for those in cardiac arrest. Until now, however, a similar study has not been conducted for neurosurgical procedures.

For the study, researchers evaluated all patients (15,807) undergoing neurological surgery between 2007 and 2014 in the University of Michigan Health System. A total of 785 complications were identified through the self-reported morbidity and mortality reports created by faculty and resident neurosurgeons.

The odds of a complication were increased by more than 50 percent for procedures with start times between 9:00 p.m. and 7:00 a.m. When taking into account the length of the surgery, the odds of a complication were even higher for later time periods. The only statistically significant factor that predicted severity of the complication was if the surgery was an emergency compared to being elective.

In addition, demographic comparisons across start time groups revealed that the average age of the patient population varied across the surgical day with older people earlier in the day, and younger people later in the day. While other patient factors varied over the course of the day, the magnitude of variation was unlikely to be clinically significant.

As expected, the percentage of elective cases decreased after daylight hours while emergency cases predominated.

The findings also found that a patient’s odds of having a surgical complication increased significantly between 9:00 p.m. and 7:00 a.m. even after accounting for whether the case was an emergency versus elective procedure or if the patient had co-morbid conditions.

When accounting for the length of a surgery, the risk of a complication more than doubled. But although these after-hour complications were much more common than daytime complications, they were not any more or less severe.

The researchers acknowledge that although the after-hour effect is a potential explanation for the increased odds of surgical complications, there could be other explanations.

 

Source: Oxford University Press USA