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Complications of daytime elective laparoscopic cholecystectomies performed by surgeons who had operated the night before

Vinden C, Nash DM, Rangrej J, Shariff SZ, Dixon SN, Jain AK, Garg AX. JAMA. 2013; 310(17):1837-41.

Importance — The effect of disrupted sleep among surgeons on patient outcomes is not clearly defined.

Objective — To assess if surgeons operating the night before have more complications of elective surgery performed the next day.

Design and Setting — Population-based, matched, retrospective cohort study using administrative healthcare databases conducted in Ontario, Canada (2012 population: 13,505,900).

Participants and Exposure — In total, 94,183 eligible elective laparoscopic cholecystectomies were performed between 2004 and 2011. Of these surgeries, there were 2,078 procedures where 331 different surgeons across 102 community hospitals had operated between midnight and 7 AM the night before. Each “at-risk” surgery was randomly matched to four other elective laparoscopic cholecystectomies (n = 8,312) performed by the same surgeon where there was no evidence they had operated the night before.

Main Outcomes — The primary outcome was conversion from a laparoscopic to open cholecystectomy. Secondary outcomes included evidence of iatrogenic injuries or death. Risks were quantified using generalized estimating equations.

Results — No significant association was found in conversion rates to open operations between surgeons operating the night before compared with when they did not operate the previous night [46/2031 (2.2%) versus 157/8124 (1.9%); adjusted odds ratio 1.18, 95% confidence interval 0.85-1.64]. There was no association between operating the night before and not operating for iatrogenic injuries [14/2031 (0.7%) versus 72/8124 (0.9%); adjusted odds ratio 0.77, 95% confidence interval 0.43-1.37] or death [≤5/2031 (≤0.2%) versus 7/8124 (0.1%).

Conclusions and Relevance — No significant association was found between operating the night before and not operating the previous night for complications of elective daytime cholecystectomy. These findings do not support safety concerns related to surgeons operating the night before performing elective surgery.

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Keywords: Surgery