Questions: When is the best time to go under the Knife?

Questions

1. Is it safer to have elective surgery first thing in the morning rather than in late afternoon, when doctors and nurses might be tired?



2. For the same reason, is it smarter to schedule surgery earlier in the workweek than later?



3. Is it better to avoid having elective surgery in July and August, when a new crop of residents has just started training?



4. Also, is it foolish to have elective surgery when the moon is full and, tradition has it, people can go a little off-kilter?

Answers

No, no, no and no, according to a Cleveland Clinic study that found timing isn't anything, at least when it comes to elective coronary bypass surgery.

The authors of the study, published today in the journal Anesthesiology, write that they decided to focus on elective heart bypass surgery because, thanks to "well-established protocols (for bypass surgery), there is much less variability than with other procedures." Plus, they write, "hospitals closely track morbidity and mortality for this operation", which is very encouraging. I am presuming that this is in an attempte to reduce it.

Daniel Sessler, an anesthesiologist who chairs the Cleveland Clinic's department of outcomes research, says he and his co-authors hope to examine whether timing affects other types of elective surgery, but they expect to find the same thing.

The researchers analysed the results of 18,597 elective bypass surgeries at the Cleveland Clinic from 1993 to 2006. Most were performed between 7 a.m. and 5 p.m. on weekdays. None of the time factors — hour, day, month or phase of moon — made any difference in the outcomes of the operations.

"Fatigue is well-known to impair performance," Sessler says, citing its role in plane and car crashes. "It's highly plausible that fatigue would impair the performance of medical personnel."

But, he says, just because doctors or nurses are fatigued and make mistakes doesn't necessarily mean patients suffer. "Hospitals have extensive systems in place to minimize the consequences of any error," he says.

I hope this has answered some of your questions but I suspect it may have raised a few more!