Outcomes of acute care surgical cases performed at night.
BACKGROUND
Acute care surgeons operate during the day and night. Time of day or night may impact the outcome because of surgeon and team fatigue, operative delays, or other unmeasured factors.


METHODS
We performed matched retrospective cohort study of patients undergoing operative intervention at night by acute care surgeons over 16 months. Cases were matched on case complexity, age, and sex to daytime cases. Other confounders including comorbidities, presenting characteristics, complications, and mortality were abstracted. Outcomes differences between day and night cases were compared.


RESULTS
Night cases (115) were matched 1:1 to daytime cases. Groups had similar degrees of comorbidity. Those operated at night had trends toward more hypotension and sepsis. After controlling for confounders using conditional logistic regression, surgical care at night was a potent predictor of mortality (odds ratio 30.02; 95% CI 2.33 to 387.40; P = .009) but had little impact on morbidity (odds ratio 1.34; 95% CI .77 to 2.36; P = .303).


CONCLUSIONS
Emergency operations performed at night by acute care surgeons may have dissimilar outcomes compared with day cases.
Department of Surgery, Yale School of Medicine, 330 Cedar Street BB 310, PO Box 208062, New Haven, CT 86520-8062, USA.
Michael K
MK
Dalton
Department of Surgery, Yale School of Medicine, 330 Cedar Street BB 310, PO Box 208062, New Haven, CT 86520-8062, USA.
Elizabeth
E
McDonald
Department of Surgery, Yale School of Medicine, 330 Cedar Street BB 310, PO Box 208062, New Haven, CT 86520-8062, USA.
Pulkesh
P
Bhatia
Department of Surgery, Yale School of Medicine, 330 Cedar Street BB 310, PO Box 208062, New Haven, CT 86520-8062, USA.
Kimberly A
KA
Davis
Department of Surgery, Yale School of Medicine, 330 Cedar Street BB 310, PO Box 208062, New Haven, CT 86520-8062, USA. Electronic address: kevin.schuster@yale.edu.
Kevin M
KM
Schuster
D000046:Academic Medical Centers; D000328:Adult; D039602:After-Hours Care / Q000379:methods*; D000368:Aged; D003422:Critical Care / Q000379:methods*; D016208:Databases, Factual; D005221:Fatigue; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000401:mortality* / Q000503:physiopathology; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D013514:Surgical Procedures, Operative / Q000379:methods* / Q000401:mortality
Acute care surgery; Fatigue; Mortality; Night; Outcomes