Time of Day Is Associated With Postoperative Morbidity

In Brief Objective: To examine the association between surgical start time and morbidity and mortality for nonemergent procedures. Summary Background Data: Patients require medical services 24 hours a day. Several studies have demonstrated a difference in outcomes over the course of the day for anesthetic adverse events, death in the ICU, and dialysis care. The relationship between operation start time and patient outcomes is yet undefined. Methods: We performed a retrospective cohort study of 144,740 nonemergent general and vascular surgical procedures performed within the VA Medical System 2000–2004 and entered into the National Surgical Quality Improvement Program Database. Operation start time was the independent variable of interest. Logistic regression was used to adjust for patient and procedural characteristics and to determine the association between start time and, in 2 independent models, mortality and morbidity. Results: Unadjusted later start time was significantly associated with higher surgical morbidity and mortality. After adjustment for patient and procedure characteristics, mortality was not significantly associated with start time. However, after appropriate adjustment, operations starting between 4 pm and 6 pm were associated with an elevated risk of morbidity (OR = 1.25, P ≤ 0.005) over those starting between 7 am and 4 pm as were operations starting between 6 pm and 11 pm (OR = 1.60, P ≤ 0.005). Conclusions: When considering a nonemergent procedure, surgeons must bear in mind that cases that start after routine "business" hours within the VA System may face an elevated risk of complications that warrants further evaluation. The frequency of medical mishaps fluctuates throughout the day. In a retrospective cohort study of 144,801 elective cases performed within the Veterans Affairs System, we examined the role of operative start time and patient outcomes after adjustment for patient and procedure characteristics. Cases that began outside of "routine business hours" were associated with elevated morbidity when compared with cases that began within "routine business hours."