On Tuesday, November 27, 2012, Dr. Youn wrote an article in CNN.com discussing the statistical worst time for a patient to undergo surgery, and what can go wrong if you have it at the “wrong” time. Dr. Youn is an assistant professor of surgery at the Oakland University/William Beaumont School of Medicine in Michigan and is the author of "In Stitches". According to Dr. Youn, the time of day you have surgery can affect your outcome, and it’s surgery team fatigue that leaves patients most at risk.
A study in 2006 at Duke University showed that operations taking place between 3 and 4 p.m. had a higher rate of nausea, vomiting and postoperative pain.
Why is this? According to Dr. Youn, there are two major factors:
Our bodies follow natural circadian rhythms, which regulate our sleep/wake cycle, brain wave activity and certain bodily functions. These circadian rhythms dip between 3 and 5 p.m. each day, causing many of us to feel sleepy. The Spaniards apparently discovered this long ago when they instituted the afternoon siesta.
Surgeons, anesthesiologists, and nurses can’t nap in the operating room! This means sleepy healthcare providers and a higher rate of adverse events post-surgery.
Factor #2: (And arguably the more important factor). Most members of the surgical team start their work day around 6:30 or 7 a.m. This means that the end of their 8 hour work day falls right in the middle of the afternoon, around 3 p.m.
What happens next may surprise you.
As soon as their shift ends, a new team comes in and takes over, sometimes right in the middle of an operation. This means that the surgeons and nurses who comforted you and told you they would take good care of you will not be the faces you see when you wake up. Instead, you’ll open your eyes and see a team of faces you’ve never seen before.
Many times, team members who are being replaced do a poor job of providing information about the patient to the oncoming team. This could mean that the replacement anesthesiologist might not be aware that you don’t respond well to a certain nausea medication.
The moral of the story? Mid-afternoon surgeries put the patient at risk (although not usually life threatening) of incurring problems after the operation. We are all human, no one can work endless hours, and we are all susceptible to an occasional mistake. But when you put your well-being in the hands of a professional caregiver, there is a certain level of expectation that goes along with that. It is their job to ensure that the surgery and recovery goes smoothly, and surgeon team fatigue is an unacceptable excuse for it going any other way.
Should you ever need surgery, make sure you choose the 7 a.m. one, and not the 3 p.m.