title: Operation Start Times and Postoperative Morbidity from Liver Resection: A Propensity Score Matching Analysis.
abstract: Surgeons are likely to get progressively fatigued and work less effectively during the course of a normal workday. We sought to examine the effects of surgery start times (morning vs. afternoon) and workload of the surgeons on morbidity of patients after partial liver resection (LR).
  
  
  
  A total of 155 pairs of the patients from 383 patients undergoing LR were generated by propensity score analysis (PSM) according to the start times of surgery: group M (morning surgery, 8 a.m.-1 p.m.) and group A (afternoon surgery, 1 p.m.-6 p.m.). Patients in group A were further divided depending on whether or not the surgeons had performed other surgeries earlier in the day and the exact duration of the other surgeries before the afternoon surgery (≤180 and >180 min). The incidence and severity of postoperative complications were compared between different groups.
  
  
  
  By using PSM analysis, the patients in group M and group A were well matched in basic characteristics. The incidence and severity of the postoperative complications were similar between the two groups (all p > 0.05). Whether the surgeons had performed other surgeries prior to the afternoon surgery seemed not affecting the postoperative outcome (all p > 0.05). Moreover, the duration of other surgeries the surgeons had performed did not have significant influence on the outcome of patients undergoing afternoon surgery (all p > 0.05).
  
  
  
  Surgery start times and workload of surgeons during working time did not measurably affect short-term outcomes of the patients. The negative findings might be a manifestation of professional judgment and self-regulation of the experienced physicians.
authors.affiliation: Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 West Yan-ta Road, Xi'an, 710061, Shaanxi Province, People's Republic of China.|Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 West Yan-ta Road, Xi'an, 710061, Shaanxi Province, People's Republic of China.|Shaanxi Provincial Regenerative Medicine and Surgical Engineering Research Center, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 West Yan-ta Road, Xi'an, 710061, Shaanxi Province, People's Republic of China.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Lu
authors.affiliation: Department of Epidemiology and Health Statistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, 710061, Shaanxi Province, China.
authors.forename: Yuan
authors.initials: Y
authors.lastname: Shen
authors.affiliation: Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 West Yan-ta Road, Xi'an, 710061, Shaanxi Province, People's Republic of China.|Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 West Yan-ta Road, Xi'an, 710061, Shaanxi Province, People's Republic of China.|Shaanxi Provincial Regenerative Medicine and Surgical Engineering Research Center, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 West Yan-ta Road, Xi'an, 710061, Shaanxi Province, People's Republic of China.
authors.forename: Jing
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 West Yan-ta Road, Xi'an, 710061, Shaanxi Province, People's Republic of China.|Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 West Yan-ta Road, Xi'an, 710061, Shaanxi Province, People's Republic of China.|Shaanxi Provincial Regenerative Medicine and Surgical Engineering Research Center, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 West Yan-ta Road, Xi'an, 710061, Shaanxi Province, People's Republic of China.
authors.forename: Yi-Fan
authors.initials: YF
authors.lastname: Ren
authors.affiliation: Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 West Yan-ta Road, Xi'an, 710061, Shaanxi Province, People's Republic of China.|Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 West Yan-ta Road, Xi'an, 710061, Shaanxi Province, People's Republic of China.|Shaanxi Provincial Regenerative Medicine and Surgical Engineering Research Center, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 West Yan-ta Road, Xi'an, 710061, Shaanxi Province, People's Republic of China.
authors.forename: Jian
authors.initials: J
authors.lastname: Dong
authors.affiliation: Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 West Yan-ta Road, Xi'an, 710061, Shaanxi Province, People's Republic of China.|Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 West Yan-ta Road, Xi'an, 710061, Shaanxi Province, People's Republic of China.|Shaanxi Provincial Regenerative Medicine and Surgical Engineering Research Center, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 West Yan-ta Road, Xi'an, 710061, Shaanxi Province, People's Republic of China.
authors.forename: Zhao-Qing
authors.initials: ZQ
authors.lastname: Du
authors.affiliation: Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 West Yan-ta Road, Xi'an, 710061, Shaanxi Province, People's Republic of China.|Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 West Yan-ta Road, Xi'an, 710061, Shaanxi Province, People's Republic of China.|Shaanxi Provincial Regenerative Medicine and Surgical Engineering Research Center, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 West Yan-ta Road, Xi'an, 710061, Shaanxi Province, People's Republic of China.
authors.forename: Xue-Min
authors.initials: XM
authors.lastname: Liu
authors.affiliation: Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 West Yan-ta Road, Xi'an, 710061, Shaanxi Province, People's Republic of China.|Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 West Yan-ta Road, Xi'an, 710061, Shaanxi Province, People's Republic of China.|Shaanxi Provincial Regenerative Medicine and Surgical Engineering Research Center, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 West Yan-ta Road, Xi'an, 710061, Shaanxi Province, People's Republic of China.
authors.forename: Zheng
authors.initials: Z
authors.lastname: Wu
authors.affiliation: Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 West Yan-ta Road, Xi'an, 710061, Shaanxi Province, People's Republic of China. luyi169@126.com.|Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 West Yan-ta Road, Xi'an, 710061, Shaanxi Province, People's Republic of China. luyi169@126.com.|Shaanxi Provincial Regenerative Medicine and Surgical Engineering Research Center, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 West Yan-ta Road, Xi'an, 710061, Shaanxi Province, People's Republic of China. luyi169@126.com.
authors.forename: Yi
authors.initials: Y
authors.lastname: Lv
authors.affiliation: Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 West Yan-ta Road, Xi'an, 710061, Shaanxi Province, People's Republic of China. xfzhang125@126.com.|Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 West Yan-ta Road, Xi'an, 710061, Shaanxi Province, People's Republic of China. xfzhang125@126.com.|Shaanxi Provincial Regenerative Medicine and Surgical Engineering Research Center, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 West Yan-ta Road, Xi'an, 710061, Shaanxi Province, People's Republic of China. xfzhang125@126.com.
authors.forename: Xu-Feng
authors.initials: XF
authors.lastname: Zhang
mesh_terms: D005221:Fatigue; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects* / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology; D057216:Propensity Score; D013997:Time Factors; D016896:Treatment Outcome; D016526:Workload