A team of researchers from the Duke University, in the US has analysed the outcomes of over 90,000 operations carried out at their hospital, and have concluded that mornings are the best time to have an operation, as they had found that more complications occur when performed in the afternoon. They have published their study in the journal Quality and Safety in Healthcare.
The researchers also stated that adverse events were most common when surgery started between 3 to 4pm and least were common during the times of 9am-noon operations. They were of the opinion that natural changes in the body's perception of pain during the day, and fatigue that would be experienced by the staff could be the reason.
Dr Melanie Wright from the university's Human Simulation and Patient Safety Centre and the lead researcher said, "Healthcare is a 24-hour-a-day business, and it is not unexpected that factors such as fatigue, circadian rhythms, personnel shift changes and scheduling may affect patient care over the course of a day."
Dr Wright's team but clarified that very few of the adverse effects that they identified caused lasting harm to the patients. They explained that most of the complications were related to problems due to pain management and postoperative nausea and vomiting. The researchers also explained that other general problems were prolonged sedation, wound infection, dangerous changes in blood pressure and equipment problems that could arise in the operating room.
The researchers mentioned that their analysis had shown around 9.497 cases had delays due to administrative issues, which they felt, though not and adverse event might influence them. They explained that when they began to match the adverse events with the time of surgery they had stumbled on a striking pattern. Dr. Wright said, "We found that adverse events were most common for operations starting between 3pm and 4pm."
She further stated that many factors could probably explain as to why this could happen, for example patients might be more susceptible to pain or postoperative nausea and vomiting in the late afternoon. She explained that issues like not eating the whole day, stress of waiting for the surgery, might also be of importance. It was also bought to notice that the late afternoon is generally the time when the anaesthetic teams in the hospital change shifts and that generally the human body would go through a drop in its natural circadian rhythm, which regulates sleep, brain wave activity and other bodily functions.
The researchers also stated that they were planning to conduct another study to compare steps in the delivery of care for patients having surgery during two time periods - 9am to noon and 3pm to 6pm.
Professor Alistair Chambers, honorary secretary of the Association of Anaesthetists of Great Britain and Northern Ireland, had explained that the findings would need to be replicated, and further pointed out that the working hours and procedures could differ between hospitals and countries. He stated that if other studies support the findings, the factors causing the difference would also need to be identified. He concluded, "But it is interesting. It perhaps does mean that we should caution against suggesting that we go to round-the-clock operating to get better use of operating theatres."