title: Operation timing does not affect outcome after coronary artery bypass graft surgery.
abstract: BACKGROUND
  Human factors such as fatigue, circadian rhythms, scheduling, and staffing may have an impact on patient care over the course of a day across all medical specialties. Research by the transportation industry concludes that human performance is degraded by shift work, circadian rhythm disturbances, and prolonged duty. This study investigated whether the timing of coronary artery bypass graft surgery affects outcomes.
  
  
  METHODS
  The outcomes of coronary artery bypass graft surgery patients were analyzed according to the hour of the day, day of the workweek, month, and moon phase in which the surgery started. All patients who underwent isolated coronary artery bypass graft surgery between January 1, 1993 and July 1, 2006 were considered for the study.The primary outcome measurement was a compound morbidity outcome of six variables defined by the Society of Thoracic Surgeons. These outcomes included (1) in-hospital death, (2) acute postoperative myocardial infarction, (3) neurologic morbidity, including focal or global neurologic deficits or death without awakening, (4) serious infection morbidity consisting of sepsis syndrome or septic shock, (5) new-onset renal failure requiring dialysis, and (6) postoperative ventilatory support exceeding 72 h.
  
  
  RESULTS
  The composite morbidity and in-hospital mortality rates were 4.8% and 1.4%, respectively. The number of cases each weekday, each month of the year, and during each phase of the moon were consistent. None of the time factors significantly affected the composite morbidity outcome.
  
  
  CONCLUSIONS
  Elective coronary artery bypass graft surgery can be scheduled throughout the workday, any day of the work week and in any month of the year without compromising outcome.
authors.affiliation: Anesthesiology Institute, Department of Quantitative Health Sciences, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Tan
authors.forename: Meng
authors.initials: M
authors.lastname: Xu
authors.forename: Daniel I
authors.initials: DI
authors.lastname: Sessler
authors.forename: C Allen
authors.initials: CA
authors.lastname: Bashour
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology / Q000401:mortality; D000368:Aged; D001026:Coronary Artery Bypass / Q000401:mortality; D003331:Coronary Vessels / Q000601:surgery*; D017558:Elective Surgical Procedures; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016081:Moon; D009203:Myocardial Infarction / Q000150:complications / Q000401:mortality; D009422:Nervous System Diseases / Q000453:epidemiology / Q000209:etiology; D019990:Perioperative Care; D011183:Postoperative Complications / Q000453:epidemiology / Q000401:mortality; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000401:mortality; D012121:Respiration, Artificial / Q000401:mortality; D018570:Risk Assessment; D012621:Seasons; D013997:Time Factors; D016896:Treatment Outcome