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Factors affecting mortality after emergency surgery: beyond time of day. A reply.

Last post 16 Nov 2018, 5:40 PM by michael tessler. 0 replies.
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  •  16 Nov 2018, 5:40 PM 2690

    Factors affecting mortality after emergency surgery: beyond time of day. A reply.

    We thank Dr Kamal for his interest in our study [1]. We included the following variables in our logistic regression model:  age, sex, ASA physical status, emergency category, day of surgery, duration of anaesthesia, and type of surgery. In the paper, we acknowledged that other pre-existing patient morbidities may have varied with the time of surgery and might have affected our results.

    We acknowledged that our inability to determine the duration of time that the patients waited for surgery was a limitation of our study and agree that this has been shown to impact postoperative mortality [2].

    We were concerned that surgical or anaesthetic sleep deprivation might have a negative impact on patient care. However, we also considered that fewer hospital personnel might be available overnight, or less familiar with the equipment needed relative to the staffing during the regular working day, also with negative consequences. Our results did not reach statistical significance (p<0.05), but we consider postoperative mortality, whilst readily quantifiable, to be an extreme end point. Further investigation is warranted to determine if there are increased morbidities caused by operating overnight relative to daytime for emergency procedures, hence the conclusion in our paper.

    M. J. Tessler

    Jewish General Hospital,

    Montreal, Canada.

    L. Charland 

    N. N. Wang

    J. A. Correa

    McGill University,

    Montreal, Canada.

    Email: mtessler@jgh.mcgill.ca

     

    No external funding and no competing interests declared.

     

    References
    1 Tessler MJ, Charland L, Wang NN, Correa JA. The association of time of emergency surgery – day, evening or night – with postoperative 30-day hospital mortality. Anaesthesia 2018; 73: 1368-712

    2  Morrissey N, Iliopoulos E, Osmani AW, Newman K.  Neck of femur fractures in the elderly:  does every hour to surgery count?  Injury 2017; 48: 1155-8.

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