title: Is nighttime the right time? Risk of complications after laparoscopic cholecystectomy at night.
abstract: BACKGROUND
  Laparoscopic cholecystectomies can be performed at night in high-volume acute care hospitals. We hypothesized that nonelective nighttime laparoscopic cholecystectomies are associated with increased postoperative complications.
  
  
  METHODS
  We conducted a single-center retrospective review of consecutive laparoscopic cholecystectomy patients between October 2010 and May 2011 at a safety-net hospital in Houston, Texas. Data were collected on demographics, operative time, time of incision, length of stay, 30-day postoperative complications (ie, bile leak/biloma, common bile duct injury, retained stone, superficial surgical site infection, organ space abscess, and bleeding) and death. Statistical analyses were performed using STATA software (version 12; Stata Corp).
  
  
  RESULTS
  During 8 months, 356 patients had nonelective laparoscopic cholecystectomies. A majority were female (n = 289 [81.1%]) and Hispanic (n = 299 [84%]). There were 108 (30%) nighttime operations. There were 29 complications in 18 patients; there were fewer daytime than nighttime patients who had at least 1 complication (4.0% vs 7.4%; p = 0.18). On multivariate analysis, age (odds ratio = 1.06 per year; 95% CI, 1.02-1.10; p = 0.002), case duration (odds ratio = 1.02 per minute; 95% CI, 1.01-1.02; p = 0.001), and nighttime surgery (odds ratio = 3.33; 95% CI, 1.14-9.74; p = 0.001) were associated with an increased risk of 30-day surgical complications. Length of stay was significantly longer for daytime than nighttime patients (median 3 vs 2 days; p < 0.001).
  
  
  CONCLUSIONS
  Age, case duration, and nighttime laparoscopic cholecystectomy were predictive of increased 30-day surgical complications at a high-volume safety-net hospital. The small but increased risk of complications with nighttime laparoscopic cholecystectomy must be balanced against improved efficiency at a high-volume, resource-poor hospital.
authors.affiliation: Department of Surgery, University of Texas Health Science Center at Houston, Houston, TX; Center for Surgical Trials and Evidence-Based Practice, University of Texas Health Science Center at Houston, Houston, TX.
authors.forename: Uma R
authors.initials: UR
authors.lastname: Phatak
authors.affiliation: Department of Surgery, University of Texas Health Science Center at Houston, Houston, TX.
authors.forename: Winston M
authors.initials: WM
authors.lastname: Chan
authors.affiliation: Department of Surgery, University of Texas Health Science Center at Houston, Houston, TX.
authors.forename: Debbie F
authors.initials: DF
authors.lastname: Lew
authors.affiliation: Department of Surgery, University of Texas Health Science Center at Houston, Houston, TX.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Escamilla
authors.affiliation: Department of Surgery, University of Texas Health Science Center at Houston, Houston, TX; Center for Surgical Trials and Evidence-Based Practice, University of Texas Health Science Center at Houston, Houston, TX.
authors.forename: Tien C
authors.initials: TC
authors.lastname: Ko
authors.affiliation: Department of Surgery, University of Texas Health Science Center at Houston, Houston, TX; Center for Surgical Trials and Evidence-Based Practice, University of Texas Health Science Center at Houston, Houston, TX.
authors.forename: Curtis J
authors.initials: CJ
authors.lastname: Wray
authors.affiliation: Department of Surgery, University of Texas Health Science Center at Houston, Houston, TX; Center for Surgical Trials and Evidence-Based Practice, University of Texas Health Science Center at Houston, Houston, TX; Center for Clinical Research and Evidence-Based Medicine, University of Texas Health Science Center at Houston, Houston, TX. Electronic address: Lillian.S.Kao@uth.tmc.edu.
authors.forename: Lillian S
authors.initials: LS
authors.lastname: Kao
mesh_terms: D000328:Adult; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D005260:Female; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D013781:Texas / Q000453:epidemiology; D013997:Time Factors