General Question

chefl's avatar

Science or anti-science: Surgery done at (x pm or x am, time of day) results in fewer complications.?

Asked by chefl (718points) 2 months ago
34 responses
“Great Question” (3points)

If a doctor tells you there would be fewer complications if you get the the surgery done at x (time of day), as opposed to the opposite time of day, (let’s say at 11pm instead of 11 am) would you go ahead or run in the other direction?

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Answers

Caravanfan's avatar

What is the surgery?

chefl's avatar

@Caravanfan Which surgery would it make a difference for?

chefl's avatar

I’ve edited the question a bit.

flutherother's avatar

I would go with what the doctor says. He (or she) knows the science but more than the science they know how the hospital operates (pun intended)

chefl's avatar

It looks like the genes, the enzymes…know what time it is, and they refuse to work properly, if it is 11am. They want 11 pm, even if they are blindfolded?

Caravanfan's avatar

@chefl So is this a purely hypothetical question? Not related to anything in reality?

chefl's avatar

But does it sound like it would makes sense if it is hypothetical?

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janbb's avatar

Doesn’t sound to me like it makes sense. And I can’t imagine any doctor that would say that. Obviously, the surgeon’s competence and level of fatigue would make a difference but there is no objective way to determine that in any given situation.

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Caravanfan's avatar

Sorry, you’ve lost me here.

gorillapaws's avatar

I’ve heard this before. The idea is surgeons are “fresher” in the AM for major surgeries than later in the day where they may be more fatigued or impatient. This seems like a plausible hypothesis, but I have no idea if the data supports such claims.

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Zaku's avatar

The scientific approach would be to do long-term controlled scientific studies on that question.

Are you asking for unscientific speculation about what we’d expect to be the case?

If so, I’d expect the proximate cause not to be the time of day per se, but the typical states of patients and people doing the work, and possibly of hospital conditions, at different times of day.

chefl's avatar

@Zaku That makes sense, But according to an emergency doctor (who talks garbage everytime he is on the air) that Lancet (medical journal) said Sugeries done at 6 pm instead of 6 am lead to fewer less complications.

chefl's avatar

…So apparently any hospital anywhere in the world.
By the way, I don’t mean Lancet couldn’t have said that, but he says it’s an “excellent” study, about that (and any study).

chefl's avatar

Even if it were in one hospital it’s not about the time of day of course.

janbb's avatar

Wouldn’t it be reasonable to access the Lancet study itself before opining about whether or not it makes sense? Maybe the time of day does matter.

chyna's avatar

I feel like I’m in bizzaro world.

Caravanfan's avatar

@chyna It’s “Bizarro”, although Bizarro is not from another world in his current iteration—he’s the result of a science experiment gone very wrong.

elbanditoroso's avatar

I have read that you don’t want to be in the hospital the first week or so after all the new residents appear at the hospital for their new residencies. That’s usually the end of June or the beginning of July.

Apparently they are fresh out of med school and pretty much have zero experience, and you take your life into your hands being in the hosptial then.

Not sure about the time of day thing.

Caravanfan's avatar

@elbanditoroso There is no evidence that hospital complications or deaths are worse in the first few weeks of residency.

smudges's avatar

23 days

Smashley's avatar

I’d go with the doc’s recommendation. I’d probably ask a follow up, and if they couldn’t tell me, I’d log that in my impressions of that doctor, but it doesn’t sound strictly unscientific to me.

Lightlyseared's avatar

There is a link between time of surgery and rate of complications, in particular surgery carried out “out of hours” It’s does not seem to be linked to the type of surgery or patient characteristics. https://www.bjanaesthesia.org/article/S0007-0912(20)30081-7/fulltext

elbanditoroso's avatar

@Caravanfan I don’t have a dog in this fight, but I did find the following:

1 which leads to 2

3 which points to several additional studies, including this

Lightlyseared's avatar

Slightly related is this paper

The best time to be admitted with a cardiac issue is when all the senior cardiologists are attending a conference. Not entirely sure what that says about cardiologists…

Healthcare is primarily delivered by humans and anything that can effect humans can effect their ability to deliver healthcare. A significant part of healthcare management is to to design systems that try to compensate.

chefl's avatar

What happens in July or July – Aug, or whatever time in hospitals in one area of the world, happens in the other months in other areas of the world.

chefl's avatar

It’s only about fatigue, shortage of x, y z people, shortage of items, etc., that contribute to problems, not the month or time of day etc. even if it just so happens some bad things happen during that time.

elbanditoroso's avatar

@Lightlyseared good catch, also an interesting factor to consider.

JLeslie's avatar

I’d go ahead. The doctor is paying attention to complication rates? That sounds like a good thing to me.

I much prefer an afternoon procedure, because I don’t want to have to get to the hospital or surgical center at the crack of dawn, but if there are more complications later in the day I’ll drag myself out of bed. If I were your surgeon I would definitely be more alert at 11:00 am than 8:00am, but other people are early birds.

Not surgery, but I had one doctor who did afternoon colonoscopies and the preparation is much easier in my opinion, plus driving well after rush hour is appreciated too. After the fact I read that the prep sometimes isn’t as effective in afternoon patients (I don’t know how good that study was) and I know mine was fine, because the doctor told me at the time. My parents always opt for afternoon colonoscopies, I haven’t run across another doctor who does it unfortunately.

chefl's avatar

@JLeslie “The doctor is paying attention to complication rates? That sounds like a good thing to me.”
To me too. The thing is the study. Not everything is the same everywhere. For example in some areas of the world wearing masks is not debatable. it’s not an issue to say the least. So, studies can’t not think about other areas.

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