View Full Version : Why You Should Avoid Afternoon Surgery

11th January 2013, 11:29 PM
If you are scheduling a surgery, you probably put some thought to the procedure itself, the surgeon who will perform the procedure and, hopefully, which hospital to go to.

But if you didn't pay much attention to the time of day your surgery is scheduled, you could be missing out on a very simple and free, yet crucially important variable in your outcome …

Patients Undergoing Afternoon Surgery May Fare Worse

A study conducted by Duke University researchers found that adverse events related to surgical anesthesia were more frequent for surgeries started between 3 pm and 4 pm than they were for those that began early in the morning, at 7 am.1

After analyzing more than 90,000 surgeries, researchers found that adverse events such as nausea, vomiting and postoperative pain were more common in the afternoon surgeries.

Among adverse events categorized as "other," which included potentially dangerous changes in blood pressure and operating room equipment problems, along with problems related to pain medication and pain management through anesthetic techniques, the predicted probability of one occurring rose from 1 percent at 9 am to over 4 percent at 4 pm.

There were other problems with afternoon surgeries too, including an increased likelihood of administrative delays, such as waiting for laboratory test results, doctors running late, transporters not being available to move patients and rooms not being ready on time, all of which have the potential to ultimately increase adverse events as well.

Fatigue, Circadian Rhythms and Shift Changes May be to Blame

As for why the afternoon may prove to be a more dangerous time for surgery, there are likely several factors involved. Among them:2

Circadian rhythm: The natural circadian rhythm, which governs sleep, brain activity and other bodily functions, dips between 3 pm and 5 pm, which may make it harder for health care professionals to stay on top of complex tasks, such as administering anesthesia.
Fatigue: Many health care workers start their days early and end their shifts right around 3 pm. This end-of-the-day fatigue, or simply their eagerness to get home, could impact their performance on the job.
Shift Changes: Anesthesia care teams often change shifts around 4 pm to 6 pm. This means you may end up with different people caring for you from the start to finish of your surgery. While essential information should be transferred between teams during the shift change, it's a prime situation for mishaps to occur.
Weekends, The Month of July Also Better Off Avoided

What's my personal recommendation when it comes to hospital stays? Naturally, my number one suggestion is to avoid hospitals unless it's an absolute emergency and you need life-saving medical attention. If you're having an elective medical procedure done, remember that this gives you greater leeway and personal choice—use it!

Many believe training hospitals will provide them with the latest and greatest care, but they can actually be more dangerous. As a general rule, avoid elective surgeries and procedures during the month of July because this is when brand new residents begin their training.

According to a 2010 report in the Journal of General Internal Medicine, lethal medication errors consistently spike by about 10 percent each July, particularly in teaching hospitals, due to the inexperience of new residents.3 Also be cautious of weekends.

source - Dr Mercola