AAOS LogoDid you know that there may be a difference between a surgery taken place at daytime and a surgery which takes place after hours? A latest study from the Department of Orthopaedic Surgery at the Washington University School of Medicine claims that patients who have after-hour orthopaedic surgeries may risk a slightly higher rate of essential follow-up surgeries.

The data also proposes that patients whose surgeries took place during the day may have the similar healing, recuperation time, and major complication rates as patients who have a surgery after hours.

William M. Ricci MD, Study lead author, Associate Professor of Orthopaedic Surgery and Chief of the Orthopaedic Trauma Service in the Department of Orthopaedic Surgery at the Washington University School of Medicine, commented, “Although everyone wants to be treated immediately, it may be in a patient’s best interest to wait until morning. The reality is that the on-call night surgical team may not be well rested as it is likely they had just finished a normal day shift.”

About 203 patients were tracked by the study. They either had femoral fracture or tibial shaft fracture and who were apparently each treated with intramedullary nail fixation i.e. a supportive rod used to stabilize the bone. The patients were split into two groups. The first group was those who had surgery between 6 am and 4 pm. The second group was the after hours group where the surgery took place between 4 pm and 6 am.

The same treatment was given to all the patients, based on the bone injured. For both the groups, the data apparently proposed similar healing time and intra-operative radiation exposure. But some prominent differences were apparently also seen by the outcome between after-hours and day-time surgeries. Unplanned follow-up operations were supposedly seen more in the after-hours group. In the after-hours group, removal of painful hardware was more frequent at 27% as opposed to the daytime group that was just 3%. In the after-hours group, the operative times were also supposedly shorter.

Dr. Ricci mentioned “The results of the study suggest that the system is working fairly well and it is not always best to rush a patient to the OR in the middle of the night. Naturally, when the medical condition is emergent and time is a critical factor, immediate surgery should proceed regardless of time of day.”

Ricci added “We, in the healthcare industry don’t have unlimited resources. Many hospitals in the U.S. do have a dedicated night team of orthopaedic surgeons who otherwise are without daytime responsibilities. There are surgical teams on-call for those instances when treatment must be immediate. For non-emergent fracture care, sufficient daytime resources should be made available to avoid unnecessary night-time surgery.”

The outcome of the study suggests that daytime operative time for orthopaedic trauma surgery may have the potential to decrease slight complication rates with intramedullary nail fixation.

This study was published in the September issue of The Journal of Bone and Joint Surgery (JBJS).