Night surgeries double risk of death

Patients are more likely to die if they undergo a surgical procedure at night, according to research presented at the World Congress of Anesthesiologists.

Researchers, led by Michael Tessler, M.D., and Ning Nan Wang, M.D., of Montreal’s McGill University Health Center, analyzed all surgical procedures over a five-year period at Montreal’s Jewish General Hospital. They then conducted an evaluation of surgical outcomes with the work day divided into day, evening and night blocks, with the start time of the anesthetic marking the time the procedure began.

Researchers initially found that among 41,716 elective and emergency procedures, 226 deaths occurred in the day compared to 97 in the evening and 29 at night, similar to the breakdown of procedure performed during the three blocks. However, after adjusting for age and overall American Society of Anesthesiologist risk scores, they found patients were 2.17 times more likely to die during nighttime surgeries than during daytime procedures, with those undergoing procedures later in the day 1.43 times more likely to die than those undergoing it during regular daytime hours.

There are numerous potential reasons for the increased risk, according to the researchers. For example, provider fatigue as the day wears on is a major concern, which has led certain providers to allow nurses to nap during breaks. It’s also possible treatment is delayed in some cases due to lack of room availability or patients being too sick to be postponed prior to treatment. 

Despite these risks, research indicates providers are increasingly hiring doctors to work overnight shifts, FierceHealthcare previously reported.