Operating the day after performing surgery the previous night not associated with adverse patient outcomes

1. This cross-sectional study demonstrated no significant increase in major surgical complications or mortality when attending physician surgeons operated the day after performing surgery during the previous night.

Evidence Rating Level: 3 (Average)

Study Rundown: Despite relatively new policies on limiting resident physicians’ work hours, no such policies were implemented for attending physicians; rather, their workload may have increased as a result of these new rules. The data are not clear as to whether patient outcomes are affected by physicians who operate the day after working overnight. This cross-sectional study evaluated the association between operating the day after working overnight with the risk of mortality and surgical complications. The data were compiled from a large multicentre registry within the United States and Netherlands, the Multicenter Perioperative Outcomes Group (MPOG), between January 1, 2010, and August 30, 2020. The primary outcome was a composite of in-hospital mortality or major surgical complications. The study’s definition of working the previous night was whether the surgeon operated any time between 11 pm and 7 am. The analysis was a within-surgeon approach, which means that surgeons were compared to themselves when they worked the night before compared to when they did not. The unadjusted incidence of mortality or major complication increased when the attending worked overnight (absolute difference: 4.06% [95% CI: 2.86-5.27; p<0.001). However, baseline patient characteristics differed between groups; after adjustment for confounding variables, the adjusted incidence of mortality or major complication after working overnight was not significantly increased (absolute adjusted difference: 0.021% [95% CI: -0.47 to 0.51]; p= 0.93). There was also no significant increase in minor complications in the adjusted analysis (absolute adjusted difference: 0.07% [95% CI: -0.24 to 0.39]; p= 0.67). Furthermore, even among physicians who worked 6-8 hours the previous night, there remained no significant difference in major complications or death (absolute adjusted difference: -0.65% [95% CI: -2.27 to 0.97]; p= 0.43). Overall, this study demonstrated that overnight operating was not associated with serious adverse patient outcomes when performing procedures the following day. However, it is important to consider that this may not apply to different institutions with different policies. Additionally, despite no difference in major patient outcomes shortly after surgery, post-discharge outcomes were not assessed.

Click to read the study in JAMA Internal Medicine

Click to read an accompanying editorial in JAMA Internal Medicine

Relevant Reading: Impact of fatigue and insufficient sleep on physician and patient outcomes: a systematic review

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