The sleepy surgeon: does night-time surgery for trauma affect mortality outcomes?

Am J Surg. 2015 Apr;209(4):633-9. doi: 10.1016/j.amjsurg.2014.12.015. Epub 2015 Jan 19.


Background: Sleepiness and fatigue affect surgical outcomes. We wished to determine the association between time of day and outcomes following surgery for trauma.

Methods: From the National Trauma Data Bank (2007 to 2010), we analyzed all adults who underwent an exploratory laparotomy between midnight and 6 am or between 7 am and 5 pm. We compared hospital mortality between these groups using multivariate logistic regression. Additionally, for each hour, a standardized mortality ratio was calculated.

Results: About 16,096 patients and 15,109 patients were operated on in the night time and day time, respectively. No difference was found in the risk-adjusted mortality rate between the 2 time periods (odds ratio .97, 95% confidence interval .893 to 1.058). However, hourly variations in mortality during the 24-hour period were noted.

Conclusion: Trauma surgery during the odd hours of the night did not have an increased risk-adjusted mortality when compared with surgery during the day.

Keywords: Fatigue; Mortality; Trauma surgery; Work hours.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Circadian Rhythm
  • Fatigue*
  • Humans
  • Middle Aged
  • Sleep Deprivation*
  • Surgeons*
  • Time Factors
  • Treatment Outcome
  • Wounds and Injuries / mortality*
  • Wounds and Injuries / surgery*
  • Young Adult