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Night Surgery Not a Factor in Transplant Mortality, JHU Study Finds

John Commins, for HealthLeaders Media, June 2, 2011

Heart and lung transplants that are done at night have no affect on patient survival, despite concerns about surgeon fatigue, a study published in the Journal of the American Medical Association has found.  

"We aren't suggesting that fatigue is good," Ashish S. Shah, MD, an assistant professor of surgery at the Johns Hopkins University School of Medicine and the study's lead author, said in a media release. "But what is important is that, at least in this specialty, it seems we're able to deal with it without subjecting the patient to risk."

The research covers 10 years of heart and lung transplants — more than 27,000 — at medical centers across the country.

"This is one of the first papers to suggest that fatigue, sleep deprivation, and odd hours really don't hurt the patient. It's a surprising finding," Shah said. "While we've felt this, other papers have suggested patients are at risk if they are treated at night. For patients undergoing heart and lung transplants, everything is fine — regardless of the hour, our study shows."

Heart and lung transplants are done whenever organs become available, without regard for the time or how much work a surgeon has already done that day, Shah said.

Previous studies have linked nighttime care with worse outcomes. One study found that nighttime cardiac arrests were associated with lower survival and unfavorable neurological outcomes. Another found that urgent orthopedic surgery at night was linked to a higher rate of unplanned reoperation. A third found that nighttime kidney transplantation was associated with higher risk of graft failure and the need for more emergency reoperation.

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