Why you should never have surgery in the evening (if you can avoid it)

Surgery is the opposite of fun, which is why you should at least know how to recover faster from an operation. Another way to make sure everything goes smoothly while you’re on the table is to schedule your surgery for earlier in the day, according to a new study published in Neurosurgery.

University of Michigan researchers pored over the medical records for 15,807 patients who underwent neurological surgery between 2007 and 2014 in the University’s health system; they identified 785 incidents of complications that had been reported by the faculty and resident neurosurgeons, which they then compared to the surgery start times. The researchers found that patients whose procedure began between 9 p.m. and 7 a.m. were 50 percent more likely to develop complications, compared to patients with a surgical start time after 7 a.m. or before 9.

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Previous research reached similar conclusions. A five-year study by the World Federation of Societies of Anaesthesiologists, presented at the World Congress of Anaesthesiologists 2016, found that patients who have surgery during the night are twice as likely to die as patients operated on during regular working hours, reported ScienceDaily. A possible explanation for their findings is the “after-hours effect,” also known as the “weekend effect”: When a task is done outside the “normal” timeframe (i.e. after-hours or on the weekend), the outcomes for that task are statistically worse.

Possible elements contributing to the “after-hours effect” may be hospital staffing issues, delays in treatment due to fewer operating rooms available, or surgeons and medical care providers being more likely to experience fatigue during anesthesia and surgery.

Lead author Aditya S. Pandey, MD, associate professor of Neurological Surgery at the University of Michigan, acknowledges that the after-hours effect is a potential factor, but there could be other explanations. For example, patients treated after normal business hours may be inherently sicker than patients treated during normal business hours in ways that the authors were unable to measure, which leads to increased complication rates.

“We need to continue to study this relationship as we aim to minimize surgery-related complications,” Pandey told EurekAlert! “Could it mean that health systems need to invest more with respect to increasing the number of surgical teams and operating rooms to allow for greater proportion of surgeries to be performed during day hours? Should urgent cases be stabilized and performed during day hours? These are important questions that must be raised as we continue to solidify the relationship between surgical start time and surgical complications.”