title: The sleepy surgeon: does night-time surgery for trauma affect mortality outcomes?
abstract: BACKGROUND
  Sleepiness and fatigue affect surgical outcomes. We wished to determine the association between time of day and outcomes following surgery for trauma.
  
  
  METHODS
  From the National Trauma Data Bank (2007 to 2010), we analyzed all adults who underwent an exploratory laparotomy between midnight and 6 am or between 7 am and 5 pm. We compared hospital mortality between these groups using multivariate logistic regression. Additionally, for each hour, a standardized mortality ratio was calculated.
  
  
  RESULTS
  About 16,096 patients and 15,109 patients were operated on in the night time and day time, respectively. No difference was found in the risk-adjusted mortality rate between the 2 time periods (odds ratio .97, 95% confidence interval .893 to 1.058). However, hourly variations in mortality during the 24-hour period were noted.
  
  
  CONCLUSIONS
  Trauma surgery during the odd hours of the night did not have an increased risk-adjusted mortality when compared with surgery during the day.
authors: Department of Surgery, Howard University, Washington, DC, USA.
authors: Syed N
authors: SN
authors: Zafar
authors: College of Medicine, Howard University, Washington, DC, USA.
authors: Laura
authors: L
authors: Libuit
authors: Department of Surgery, Center for Surgical Trials and Outcomes Research, Johns Hopkins University, Baltimore, MD, USA.
authors: Zain G
authors: ZG
authors: Hashmi
authors: Department of Surgery, Howard University, Washington, DC, USA.
authors: Kakra
authors: K
authors: Hughes
authors: Department of Surgery, Howard University, Washington, DC, USA.
authors: Wendy R
authors: WR
authors: Greene
authors: Department of Surgery, Howard University, Washington, DC, USA.
authors: Edward E
authors: EE
authors: Cornwell
authors: Department of Surgery, Center for Surgical Trials and Outcomes Research, Johns Hopkins University, Baltimore, MD, USA.
authors: Adil H
authors: AH
authors: Haider
authors: Department of Surgery, Howard University, Washington, DC, USA.
authors: Terrence M
authors: TM
authors: Fullum
authors: Department of Surgery, Howard University, Washington, DC, USA. Electronic address: daniel.tran@howard.edu.
authors: Daniel D
authors: DD
authors: Tran
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002940:Circadian Rhythm; D005221:Fatigue; D006801:Humans; D008875:Middle Aged; D012892:Sleep Deprivation; D066231:Surgeons; D013997:Time Factors; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000401:mortality* / Q000601:surgery*; D055815:Young Adult
keywords: Fatigue; Mortality; Trauma surgery; Work hours