title: Is after-hours free-flap surgery associated with adverse outcomes?
abstract: OBJECTIVE
  Recently, there has been increasing interest in system-based approaches to improve patient safety, including the concern of the risks of after-hours surgery. Although several studies have demonstrated worse outcomes associated with night surgery, little is known regarding the effects of after-hours surgery on microsurgery fields. Here, we evaluated the hypothesis that after-hours microsurgery could increase the risk of postoperative complications.
  
  
  METHODS
  A retrospective case-control study was performed of patients who underwent elective microsurgical reconstruction between January 2004 and March 2012. Patients were categorised into an after-hours group defined as an operation starting between 4 pm and 7 am or a daytime group defined as an operation starting between 7 am and 4 pm.
  
  
  RESULTS
  A total of 454 patients were included, with 345 patients in the daytime group and 109 patients in the after-hours group. Flap-compromised complications were observed in 24 patients (5.3%), including 13 (2.9%) total losses and 11 (2.4%) partial losses. After-hours surgery was associated with a higher risk of total flap loss (p = 0.011) and re-exploration (p = 0.004), which remained significant in multivariate analysis (p = 0.018; p = 0.002). Total flap salvage was possible in 18 of 31 (58.1%) of re-explorations, and a significantly higher success rate was observed in the daytime group (p = 0.027). Total length of hospital stay was significantly longer in the after-hours group (p = 0.039). Minor complication rates did not show significant differences between the groups.
  
  
  CONCLUSIONS
  After-hours performance of elective free flap surgery was demonstrated to be associated with increased risk of flap-related complications.
authors: Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-dong 50, Gangnam-gu, Seoul 135-710, South Korea.
authors: Kyeong-Tae
authors: KT
authors: Lee
authors: Goo-Hyun
authors: GH
authors: Mun
mesh_terms: D000293:Adolescent; D000328:Adult; D039602:After-Hours Care; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D002648:Child; D005260:Female; D058752:Free Tissue Flaps; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000453:epidemiology; D013514:Surgical Procedures, Operative; D055815:Young Adult