There have been concerns that surgeon fatigue is resulting in dangerous complications for patients, and data shows worse results for several patients who undergo surgery at night. However, according to a new Johns Hopkins research, in case of heart and lung transplants there is no relation between time of day and patient survival.
“We aren’t suggesting that fatigue is good,” states lead author of the study Ashish S. Shah, an assistant professor of surgery at the Johns Hopkins University School of Medicine.”But what is important is that, at least in this specialty, it seems we’re able to deal with it without subjecting the patient to risk.”
Appearing in the Journal of the American Medical Association, the study covers a decade of lung and heart transplants over 27,000 of them at medical centers throughout the U.S.
“This is one of the first papers to suggest that fatigue, sleep deprivation and odd hours really don’t hurt the patient. It’s a surprising finding,” states Shah. “While we’ve felt this, other papers have suggested patients are at risk if they are treated at night. For patients undergoing heart and lung transplants, everything is fine regardless of the hour, our study shows.”
The research team reviewed United Network of Organ Sharing (UNOS) data on all adult heart and lung transplants that took place in the U.S. between Jan. 2000 and Jun. 2010. At total of 16,573 heart transplants were performed during this time period, half during the day and half at night. The survival rate after one year was 88% for daytime recipients and 87.7% for nighttime recipients. An operation was categorized as a daytime operation by the team if the critical portion of the surgery was performed during the day.
A total of 10,545 lung transplants were performed during the 10-year period, around half during the day and half at night. The survival rate after one year was 83.8% for daytime recipients and 82.6% for nighttime recipients.
In Shah’s opinion, the success in heart and lung transplant results, regardless of the time of day, is a testament to experienced transplant teams who have learned how to effectively perform complex surgeries on very sick patients, despite fatigue and emotional stress.
Shah says that heart and lung transplant teams can be role models for others, and researchers may learn something from analyzing the factors that contribute to their success and use that knowledge for improving results in other specialties.
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