Time-of-day effects on surgical outcomes in the private sector: a retrospective cohort study.
ABSTRACT Surgical care is delivered around the clock. Elective cases within the Veterans Affairs health system starting after 4 pm appear to have an elevated risk of morbidity, but not mortality, compared with earlier cases. The relationship between operation start time and patient outcomes is not described in private-sector patients or for emergency cases.
We performed a retrospective cohort study of 56,920 general and vascular surgical procedures performed from October 2001 through September 2004, and entered into the National Surgical Quality Improvement Program database. Operation start time was the independent variable of interest. Random effects, hierarchical logistic regression models adjusted for patient, operative, and facility characteristics. Two independent models determined associations between start time and morbidity or mortality. Subset analysis was performed for emergency and nonemergency cases.
After adjustment for patient and procedure characteristics, mortality had a moderately strong association with start time, but only for nonemergency cases starting 9:30 pm to 7:30 am (odds ratio = 1.752; p = 0.028; reference 7:30 am to 9:30 am). As for morbidity, after adjustment, operations starting 9:30 am to 1:30 pm and 5:30 pm to 9:30 pm were associated with a weakly elevated risk of morbidity, but those starting 9:30 pm to 7:30 am demonstrated a strong effect on morbidity (odds ratio = 1.32; p < 0.0001). Subgroup analysis showed this effect was largely a result of elevated risk of morbidity in emergency cases from this overnight time period (odds ratio = 1.48; p = 0.001).
Surgical start times are associated with risk-adjusted patient outcomes. In terms of facility operations management and resource allocation, consideration should be given to the capacity to accommodate cases with differences in risk during different time periods.
- The spine journal: official journal of the North American Spine Society 04/2014; 14(4):725-6. · 2.90 Impact Factor
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ABSTRACT: BACKGROUND: Perioperative care of patients undergoing colon resection requires a multidisciplinary approach by the operating surgeon, residents, and nurses. Operations performed on Monday take full advantage of hospital resources throughout the week to meet expected discharge by Friday. In a current health care environment of diminishing means, improving the timing of surgery in relation to expected length of stay may play an important role in preserving health care resources. METHODS: A retrospective review of a prospectively collected colorectal surgical database identified all patients who underwent segmental colon resection at a single tertiary care referral center from 2004 to 2010. Length of stay for patients undergoing elective open and minimally invasive segmental colectomy was compared for Monday versus Tuesday through the weekend. Patient and surgeon demographics were recorded as well as postoperative outcomes and complications. RESULTS: A total of 868 segmental colectomies were performed during the study period. Length of stay was significantly decreased by .73 days (P < .01) for all segmental colectomies performed on Monday compared with those performed Tuesday through Sunday. There was also a significant decrease in length of stay looking independently at right (.96 days, P < .01) and left or sigmoid colectomies (.56 days, P < .01). There was no significant difference in patient or surgeon demographics to account for this difference. CONCLUSIONS: Segmental colectomies have a significantly decreased length in stay when performed on Monday compared with the rest of the week. The decrease is independent of surgeon, comorbidities, and complications. This difference may be the result of patients' taking full advantage of hospital resources and ancillary support. Cost-effective measures may be evaluated and directed at adjustment of resources available throughout the week to reduce length of stay.American journal of surgery 05/2013; · 2.36 Impact Factor
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ABSTRACT: This article presents the results of investigations on the pulverizing grinding energy requirements for whole and preliminary ground wheat kernels regarding different moisture levels. Four common wheat cultivars (Triticum aestivum, ssp. vulgare) differing in kernel hardness were used for tests. When the moisture of kernels ranged from 14% to 20% w.b. the lower values of average particle size were obtained for preliminary ground wheat. The pulverizing energy requirements expressed by different grinding indices were considerably lower for preliminary ground kernels rather than for whole kernels. The values of specific pulverizing energy ranged from 32.6 to 79.0kJkg−1 for whole kernels, whereas the values of total specific grinding energy (the sum of specific grinding energy and specific pulverizing energy) changed from 23.1 to 44.4kJkg−1 for the two-stage ground wheat. In addition, the other values of pulverizing indices confirmed that preliminary size reduction significantly reduced the grinding energy requirements.Journal of Food Engineering 06/2011; 104(4):585-591. · 2.58 Impact Factor