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.

"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 October 20, 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 October 20, 2014).

Share This



More Health & Medicine News

Monday, October 20, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Microneedle Patch Promises Painless Pricks

Microneedle Patch Promises Painless Pricks

Reuters - Innovations Video Online (Oct. 18, 2014) Researchers at The National University of Singapore have invented a new microneedle patch that could offer a faster and less painful delivery of drugs such as insulin and painkillers. Video provided by Reuters
Powered by NewsLook.com
Raw: Nurse Nina Pham Arrives in Maryland

Raw: Nurse Nina Pham Arrives in Maryland

AP (Oct. 17, 2014) The first nurse to be diagnosed with Ebola at a Dallas hospital walked down the stairs of an executive jet into an ambulance at an airport in Frederick, Maryland, on Thursday. Pham will be treated at the National Institutes of Health. (Oct. 16) Video provided by AP
Powered by NewsLook.com
Raw: Cruise Ship Returns to US Over Ebola Fears

Raw: Cruise Ship Returns to US Over Ebola Fears

AP (Oct. 17, 2014) A Caribbean cruise ship carrying a Dallas health care worker who is being monitored for signs of the Ebola virus is heading back to Texas, US, after being refused permission to dock in Cozumel, Mexico. (Oct. 17) Video provided by AP
Powered by NewsLook.com
Spanish Govt: Four Suspected Ebola Cases in Spain Test Negative

Spanish Govt: Four Suspected Ebola Cases in Spain Test Negative

AFP (Oct. 17, 2014) All four suspected Ebola cases admitted to hospitals in Spain on Thursday have tested negative for the deadly virus in a first round of tests, the government said Friday. Duration: 00:55 Video provided by AFP
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