There is growing concern over the impact of fatigue and long work hours on patient safety. Our objective was to determine the perioperative outcomes and hospital costs associated with starting nonemergent cardiac surgical cases after 3 pm.
Methods
A retrospective analysis was performed on adult patients who underwent elective coronary artery bypass or valve surgery at our institution between July 2011 and March 2018. Cases were defined as “late start” if the incision time was after 3 pm. Postoperative outcomes, 30-day mortality, and total hospital costs were compared between propensity-matched samples of early-starting and late-starting cases.
Results
Of 2463 elective cases, 352 (14%) started after 3 pm. In propensity-matched samples, patients who had a late start demonstrated no difference in 30-day mortality (1% vs <1%; P = .10) or postoperative complications, such as prolonged ventilation (5% vs 7%; P = .37), renal failure (2% vs 1%), or stroke (2% vs 1%; P = .23) compared with patients who had an early start. A late start did not impact the median duration of ventilation (4 vs 5 hours; P = .72), intensive care unit (ICU) length of stay (26 vs 22 hours; P = .28), or postoperative length of stay (6 vs 7 days; P = .37). In addition, there were no significant differences in total hospital cost (P = .09), operating room cost (P = .22), or ICU cost (P = .05).
Conclusions
We report no differences in perioperative outcomes, operative mortality, length of stay, or total hospital cost for elective cases that start after 3 pm. This may be attributable to the resources available at a large quaternary center regardless of time of day.
Graphical abstract
Overview of the study design, which demonstrates equivalent outcomes and hospital costs for early- vs late-starting elective cardiac surgery cases.
