Featured Research

from universities, journals, and other organizations

Nighttime surgery not a factor in survival for heart and lung transplants: 'Surprising' finding shows no impact of presumed surgeon fatigue at night

Date:
May 31, 2011
Source:
Johns Hopkins Medical Institutions
Summary:
Despite concerns that surgeon fatigue is leading to dangerous complications for patients and data showing worse outcomes for many patients who undergo surgery at night, new research suggests that -- in the case of heart and lung transplants -- time of day has no affect on patient survival.

Despite concerns that surgeon fatigue is leading to dangerous complications for patients and data showing worse outcomes for many patients who undergo surgery at night, new Johns Hopkins research suggests that -- in the case of heart and lung transplants -- time of day has no affect on patient survival.

Related Articles


"We aren't suggesting that fatigue is good," says Ashish S. Shah, an assistant professor of surgery at the Johns Hopkins University School of Medicine and the study's lead author. "But what is important is that, at least in this specialty, it seems we're able to deal with it without subjecting the patient to risk."

The research, , described in the Journal of the American Medical Association, covers 10 years of heart and lung transplants -- more than 27,000 of them -- at medical centers across the United States.

"This is one of the first papers to suggest that fatigue, sleep deprivation and odd hours really don't hurt the patient. It's a surprising finding," Shah says. "While we've felt this, other papers have suggested patients are at risk if they are treated at night. For patients undergoing heart and lung transplants, everything is fine -- regardless of the hour, our study shows."

Heart and lung transplants are done whenever scarce organs become available, without regard for the clock or how much work a surgeon has already done that day, Shah noted, likely making results of the Hopkins study especially reassuring to patients and surgical teams.

Researchers have long worked to identify factors that contribute to medical errors, and attention has focused especially on medical staff fatigue associated with medical care outside of daytime hours. Several previous studies have linked nighttime care with worse outcomes. One study found that nighttime cardiac arrests were associated with lower survival and unfavorable neurological outcomes. Another found that urgent orthopedic surgery at night was linked to a higher rate of unplanned reoperation. A third found that nighttime kidney transplantation was associated with higher risk of graft failure and the need for more emergency reoperation.

Shah says it would not have surprised the researchers to find the same issues with heart and lung transplants, especially with the complication of postoperative bleeding not uncommon after complex cardiac surgery. Theoretically, surgeon fatigue could lead to careless technique, resulting in additional bleeding requiring reoperation, or it could increase the tendency to overlook surgical bleeding. But Shah and his colleagues found that the rate of reoperation was the same regardless of operative time of the day. The team also found that hospital length of stay was the same no matter what time the surgery took place.

In the new study, Shah and his colleagues reviewed United Network of Organ Sharing (UNOS) data on all adult heart and lung transplants in the United States between January 2000 and June 2010. Of the 16,573 who underwent heart transplants, half were done during the day and half at night. After one year, the survival rate for heart transplants was 88 percent for daytime recipients and 87.7 percent for those who got their new hearts at night. Researchers categorized daytime operations as those where the critical portion of the surgery took place during the day. Successful heart transplants can take as many as five to 10 hours to complete, says Shah, a cardiac surgeon.

For the 10,545 lung transplants, roughly half were done during the day and half at night. After one year, 83.8 percent of those who got their organs during the day were still alive, compared to 82.6 percent of those who had their surgeries at night.

Shah says he thinks the success in heart and lung transplant outcomes, no matter the time of day, is a testament to experienced transplant teams who have figured out how to effectively perform complex surgeries on very sick patients, despite fatigue and emotional stress.

Shah says his new findings are a good example of the need for more outcomes research like the current one. Without specifically looking at the question of fatigue and medical errors in heart and lung transplants, the assumption would have been that, as in many other cases, these surgeries are less safe when done at night, he says.

"It's worth asking these questions rather than extrapolating the conclusions from other specialties," he says.

Heart and lung transplant teams could serve as a model for others, Shah says, and researchers may learn something from examining why they are so successful and using that knowledge to improve outcomes in other specialties.

Other researchers involved in the study, all from Johns Hopkins, are Timothy J. George, M.D.; George J. Arnaoutakis, M.D.; Christian A. Merlo, M.D., M.P.H.; Clinton D. Kemp, M.D.; William A. Baumgartner, M.D.; and John V. Conte, M.D.


Story Source:

The above story is based on materials provided by Johns Hopkins Medical Institutions. Note: Materials may be edited for content and length.


Journal Reference:

  1. Timothy J. George, George J. Arnaoutakis, Christian A. Merlo, Clinton D. Kemp, William A. Baumgartner, John V. Conte, Ashish S. Shah. Association of Operative Time of Day With Outcomes After Thoracic Organ Transplant. JAMA, 2011; 305 (21): 2193-2199 DOI: 10.1001/jama.2011.726

Cite This Page:

Johns Hopkins Medical Institutions. "Nighttime surgery not a factor in survival for heart and lung transplants: 'Surprising' finding shows no impact of presumed surgeon fatigue at night." ScienceDaily. ScienceDaily, 31 May 2011. <www.sciencedaily.com/releases/2011/05/110531162138.htm>.
Johns Hopkins Medical Institutions. (2011, May 31). Nighttime surgery not a factor in survival for heart and lung transplants: 'Surprising' finding shows no impact of presumed surgeon fatigue at night. ScienceDaily. Retrieved December 18, 2014 from www.sciencedaily.com/releases/2011/05/110531162138.htm
Johns Hopkins Medical Institutions. "Nighttime surgery not a factor in survival for heart and lung transplants: 'Surprising' finding shows no impact of presumed surgeon fatigue at night." ScienceDaily. www.sciencedaily.com/releases/2011/05/110531162138.htm (accessed December 18, 2014).

Share This


More From ScienceDaily



More Health & Medicine News

Thursday, December 18, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

UN: Up to One Million Facing Hunger in Ebola-Hit Countries

UN: Up to One Million Facing Hunger in Ebola-Hit Countries

AFP (Dec. 17, 2014) Border closures, quarantines and crop losses in West African nations battling the Ebola virus could lead to as many as one million people going hungry, UN food agencies said on Wednesday. Duration: 00:52 Video provided by AFP
Powered by NewsLook.com
When You Lose Weight, This Is Where The Fat Goes

When You Lose Weight, This Is Where The Fat Goes

Newsy (Dec. 17, 2014) Can fat disappear into thin air? New research finds that during weight loss, over 80 percent of a person's fat molecules escape through the lungs. Video provided by Newsy
Powered by NewsLook.com
Why Your Boss Should Let You Sleep In

Why Your Boss Should Let You Sleep In

Newsy (Dec. 17, 2014) According to research out of the University of Pennsylvania, waking up for work is the biggest factor that causes Americans to lose sleep. Video provided by Newsy
Powered by NewsLook.com
Flu Outbreak Closing Schools in Ohio

Flu Outbreak Closing Schools in Ohio

AP (Dec. 17, 2014) A wave of flu illnesses has forced some Ohio schools to shut down over the past week. State officials confirmed one pediatric flu-related death, a 15-year-old girl in southern Ohio. (Dec. 17) Video provided by AP
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:

Strange & Offbeat Stories


Health & Medicine

Mind & Brain

Living & Well

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins