title: Operative start times and complications after kidney transplantation.
abstract: The worldwide focus on work hour regulations and patient safety has led to the re-examination of the merits of night-time surgery, including kidney transplantation. The risks of operating during nontraditional work hours with potentially fatigued surgeons and staff must be weighed against the negative effects of prolonged cold ischemic time with resultant graft compromise. The aim of this study was to evaluate the impact of performing renal transplantation procedures during evening versus day time hours. The main outcome measures assessed between the day and night cohorts included comparisons of the postoperative complication rates and survival outcomes for both the renal allograft and the patient. A retrospective review of 633 deceased donor renal transplants performed at a single institution was analyzed. Three statistically significant results were noted, namely, a decrease in vascular complications in the nighttime cohort, an increase in urologic complications on subgroup analysis in the 3 AM to 6 AM cohort, and the 12 AM to 3 AM subgroup had the greatest odds of any complication. There was no statistical difference in either patient or graft survival over a twelve month period following transplantation. We conclude that although the complication rate varied among cohorts this was clinically insignificant and there was no overall clinically relevant impact on patient or graft survival.
authors.affiliation: Department of Urology, Wright Patterson Medical Center, WPAFB, OH, USA.
authors.forename: Tavis M
authors.initials: TM
authors.lastname: Shaw
authors.forename: Bonnie E
authors.initials: BE
authors.lastname: Lonze
authors.forename: Eyob L
authors.initials: EL
authors.lastname: Feyssa
authors.forename: Dorry L
authors.initials: DL
authors.lastname: Segev
authors.forename: Noah
authors.initials: N
authors.lastname: May
authors.forename: Afshin
authors.initials: A
authors.lastname: Parsikia
authors.forename: Stalin
authors.initials: S
authors.lastname: Campos
authors.forename: Kamran
authors.initials: K
authors.lastname: Khanmoradi
authors.forename: Radi F
authors.initials: RF
authors.lastname: Zaki
authors.forename: Jorge A
authors.initials: JA
authors.lastname: Ortiz
mesh_terms: D000328:Adult; D051799:Delayed Graft Function; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors