title: What is the safety of nonemergent operative procedures performed at night? A study of 10,426 operations at an academic tertiary care hospital using the American College of Surgeons national surgical quality program improvement database.
abstract: BACKGROUND
  Ever-increasing numbers of in-house acute care surgeons and competition for operating room time during normal daytime business hours have led to an increased frequency of nonemergent general and vascular surgery procedures occurring at night when there are fewer residents, consultants, nurses, and support staff available for assistance. This investigation tests the hypothesis that patients undergoing such procedures after hours are at increased risk for postoperative morbidity and mortality.
  
  
  METHODS
  Clinical data for 10,426 operative procedures performed over a 5-year period at a single academic tertiary care hospital were obtained from the American College of Surgeons National Surgical Quality Improvement Program Database. The prevalence of preoperative comorbid conditions, postoperative length of stay, morbidity, and mortality was compared between two cohorts of patients: one who underwent nonemergent operative procedures at night and other who underwent similar procedures during the day. Subsequent statistical comparisons utilized chi tests for comparisons of categorical variables and F-tests for continuous variables.
  
  
  RESULTS
  Patients undergoing procedures at night had a greater prevalence of serious preoperative comorbid conditions. Procedure complexity as measured by relative value unit did not differ between groups, but length of stay was longer after night procedures (7.8 days vs. 4.3 days, p < 0.0001).
  
  
  CONCLUSIONS
  Patients undergoing nonemergent general and vascular surgery procedures at night in an academic medical center do not seem to be at increased risk for postoperative morbidity or mortality. Performing nonemergent procedures at night seems to be a safe solution for daytime overcrowding of operating rooms.
authors.affiliation: Department of Surgery, University of Virginia, Charlottesville, Virginia, USA.
authors.forename: Florence E
authors.initials: FE
authors.lastname: Turrentine
authors.forename: Hongkun
authors.initials: H
authors.lastname: Wang
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Young
authors.forename: James Forrest
authors.initials: JF
authors.lastname: Calland
mesh_terms: D000046:Academic Medical Centers; D016009:Chi-Square Distribution; D016208:Databases, Factual; D017558:Elective Surgical Procedures / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006785:Hospitals, University; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008505:Medical Staff, Hospital / Q000706:statistics & numerical data; D009551:Night Care / Q000592:standards / Q000706:statistics & numerical data*; D009873:Operating Rooms / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000453:epidemiology*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011785:Quality Assurance, Health Care / Q000706:statistics & numerical data*; D018570:Risk Assessment; D017751:Safety Management; D013514:Surgical Procedures, Operative / Q000009:adverse effects / Q000592:standards / Q000706:statistics & numerical data*; D015996:Survival Rate; D014481:United States; D014940:Work Schedule Tolerance