Night surgeries linked to risks

Performing surgeries at night could lead to adverse health consequences.

A new study published in the Neurosurgery journal found that patients who undergo neurosurgical procedures between 9pm and 7am are at an increased risk of developing complications compared to those that do it earlier in the day.

Neurosurgery is a branch of surgery that focuses on the diagnosis and treatment of disorders or injuries of the brain and spinal cord.

This was the first study that sought to specifically analyse the impact of late night operations on people with neurological disorders.

During the study period, the researchers analysed more than 15,000 patients who had the surgery between 2007 and 2014 in the University of Michigan Health System. They found that those who underwent the medical procedure between 9pm and 7am had a 50 per cent increased chance of developing complications.

The risk persisted in all categories of patients — those that had elective or emergency surgery and those who with or without underlying health problems at the time of surgery.

When accounting for the length of the surgery, the odds of complications more than doubled among those that had long surgeries, lasting for many hours. In this group, the adverse complications were much more common than among individuals whose surgery took a short period.

Dr Aditya Pandey, lead author of the study stated that the link between late surgeries and adverse health effects need to be continuously studied to find ways of minimising surgery-related complications.

Based on the findings, he noted that perhaps health systems could channel more investment towards increasing the number of surgical teams and operating rooms to allow for greater proportion of surgeries to be performed during day hours.

He added that they could also consider stabilising urgent surgical cases so that the operations that can be 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.”

Previous studies that looked at other types of surgery such a coronary angioplasty, orthopaedic, transplant, colorectal surgery and cardiac arrest that also indicated that the time the medical procedure begins is of utmost importance to the success of the treatment.

These past studies showed that if the task is accomplished outside the usual timeframe (after normal working hours or over the weekends) then its outcomes are likely to be statistically worse.

However, authors of this new study acknowledge that even though conducting surgeries during ‘abnormal’ hours seems to be a potential cause for the increased odds of complications with late night surgeries, there could be other reasons. For instance, they note that the enhanced complications could be due to the fact that patients treated after normal business hours — in the study — were inherently sicker than those treated during normal hours in ways that the researchers were unable to measure.

Other contributors to night-time surgical complications include fatigue among medical staff, overnight staffing shortages and treatment delays.

Common neurological disorders include epilepsy, migraine headaches, brain concussions, brain tumours, spinal cord injuries, back problems, Parkinson disease, Alzheimer’s disease, cerebral palsy, multiple sclerosis and muscular dystrophy. Not all of these conditions will require surgery.

Some of the complications that may result from brain surgery include speech or memory problems, blood clots or bleeding in the brain, body balance or co-ordination challenges, infections in the wound or the skull, muscle weakness, brain swelling, coma, strokes or seizures.

These problems may be temporary or permanent depending on the severity of the complications and ability of hospitals to identify them and take appropriate actions – early enough – so as to improve health outcomes and enhance quick recovery among affected individuals.