# Why might major surgery be scheduled in the middle of the night? **URL:** \ **Category:** Factual Questions\ **Created:** [December 28, 2018, 4:53pm UTC](https://boards.straightdope.com/t/why-might-major-surgery-be-scheduled-in-the-middle-of-the-night/826836 "2018-12-28T16:53:50Z")\ **Posts on this page:** 18\ **Page:** 2
**Author:** ![Shmendrik](https://avatars.discourse-cdn.com/v4/letter/s/ee7513/32.png) [@Shmendrik](https://boards.straightdope.com/u/Shmendrik)\ **Post date:** [December 28, 2018, 10:16pm UTC](https://boards.straightdope.com/t/why-might-major-surgery-be-scheduled-in-the-middle-of-the-night/826836/21 "2018-12-28T22:16:55Z")
> [@Shmendrik](#): > > No, the correct answer has been given several time already… Most organs for translate have a very short shelf life. At the same time, brain dead donors tend to become increasingly physiologically unstable as time goes on, so one can’t simply retrieve the organs at a convenient time. The recipient may have been informed 12 hours earlier that the transplant team was flying out to another city to retrieve the heart. > > Sent from my Moto G (5) Plus using Tapatalk \*transplant, not translate. DYAC Sent from my Moto G (5) Plus using Tapatalk ---
**Author:** ![KarlGauss](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/karlgauss/32/3713_2.png) [@KarlGauss](https://boards.straightdope.com/u/KarlGauss)\ **Post date:** [December 29, 2018, 2:01am UTC](https://boards.straightdope.com/t/why-might-major-surgery-be-scheduled-in-the-middle-of-the-night/826836/22 "2018-12-29T02:01:39Z")
> [@JB99](#): > > . . . I’ve also heard the death rate spikes in the summer, because that’s when the new graduates are starting. Well, ‘spike’ may be a bit of a stretch, but death rates go up on weekends (and, similarly, when staffing rates are down and the frontline staff overall less experienced or fatigued). As far as I know [THIS NEJM article from 2001](https://www.nejm.org/doi/full/10.1056/NEJMsa003376) was the first to demonstrate the phenomenon. The observation has since been extended by the [same authors](https://www.ncbi.nlm.nih.gov/pubmed/27754897) and [others](https://www.ncbi.nlm.nih.gov/pubmed/29251716). ---
**Author:** ![Doug\_K](https://avatars.discourse-cdn.com/v4/letter/d/b5ac83/32.png) [@Doug\_K](https://boards.straightdope.com/u/Doug_K)\ **Post date:** [December 29, 2018, 5:06am UTC](https://boards.straightdope.com/t/why-might-major-surgery-be-scheduled-in-the-middle-of-the-night/826836/23 "2018-12-29T05:06:46Z")
My father-in-law had bypass surgery at midnight. The surgeon said it wasn’t a big deal to do surgery that late. ---
**Author:** ![nightshadea](https://avatars.discourse-cdn.com/v4/letter/n/7ba0ec/32.png) [@nightshadea](https://boards.straightdope.com/u/nightshadea)\ **Post date:** [December 29, 2018, 6:04am UTC](https://boards.straightdope.com/t/why-might-major-surgery-be-scheduled-in-the-middle-of-the-night/826836/24 "2018-12-29T06:04:06Z")
yeah my gallbladder was removed at 3 am that wasn’t unusual its just when they had a open few hours …… ---
**Author:** ![Si\_Amigo](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/si_amigo/32/2877_2.png) [@Si\_Amigo](https://boards.straightdope.com/u/Si_Amigo)\ **Post date:** [December 29, 2018, 6:42pm UTC](https://boards.straightdope.com/t/why-might-major-surgery-be-scheduled-in-the-middle-of-the-night/826836/25 "2018-12-29T18:42:00Z")
Trauma centers run 24/7 and often see victims after midnight. Gun shots, stabbings, heart attacks and strokes don’t always happen during business hours. [Mine was done at 1:00 in the morning on a Sunday](https://boards.straightdope.com/sdmb/showthread.php?t=692871&highlight=stabbed) and involved a team of heart surgeons. Trauma teams typically work multiple shifts. ---
**Author:** ![JB99](https://avatars.discourse-cdn.com/v4/letter/j/439d5e/32.png) [@JB99](https://boards.straightdope.com/u/JB99)\ **Post date:** [December 29, 2018, 7:02pm UTC](https://boards.straightdope.com/t/why-might-major-surgery-be-scheduled-in-the-middle-of-the-night/826836/26 "2018-12-29T19:02:55Z")
> [@doorhinge](#): > > Measurably? It sounds like you’ve been listening to some ol’ wives tales. Or you’re confusing surgery with those 50’s, 60’s, 70’s Detroit auto line manufacturing rumors. I’ve also heard the same rumors concerning Harley Davidson motor scooter manufacture. AFAIK, none of these rumors are true. So Duke University’s study is a work of fiction? [https://articles.mercola.com/sites/articles/archive/2013/01/10/amp/afternoon-surgery.aspx](https://articles.mercola.com/sites/articles/archive/2013/01/10/amp/afternoon-surgery.aspx) > [@](#): > > In the real world, surgical teams are highly trained, highly motivated, and deathly afraid of having to testify in court due to someone’s error. There are hospital surgical procedures in place that require all errors/mistakes/misjudgments be reported, addressed, and corrected in a timely manner. The fact that errors/mistakes/misjudgments get reported has nothing whatsoever to do with the question of how or when they happen. But I’m sure those highly trained, highly motivated teams of surgeons are just wasting their money on malpractice insurance because they never make mistakes… [https://well.blogs.nytimes.com/2007/11/28/when-surgeons-cut-the-wrong-body-part/](https://well.blogs.nytimes.com/2007/11/28/when-surgeons-cut-the-wrong-body-part/) > **[Doctor Who Cut Off Wrong Leg Is Defended by Colleagues (Published 1995)](https://www.nytimes.com/1995/09/17/us/doctor-who-cut-off-wrong-leg-is-defended-by-colleagues.html)** … like going to medical school for eight years without learning the difference between right and left. ---
**Author:** ![Melbourne](https://avatars.discourse-cdn.com/v4/letter/m/b5e925/32.png) [@Melbourne](https://boards.straightdope.com/u/Melbourne)\ **Post date:** [December 29, 2018, 9:07pm UTC](https://boards.straightdope.com/t/why-might-major-surgery-be-scheduled-in-the-middle-of-the-night/826836/28 "2018-12-29T21:07:22Z")
> [@bordelond](#): > > Understood, but unless I am missing something … this surgery was scheduled at least several days in advance. Maybe I am wrong about that. > > EDIT: upon reading the beginning of the article again, and looking at the iPhone image of the texts sent, the patient might actually have only been notified something like 14 or 15 hours in advance of the surgery. The patient texted the journalist at 12:45 p.m. that he would be having the transplant at 1 a.m. The time and date may have been set by the time and date when life support was turned off. Getting agreement for organ use is a sensitive subject, and you may have to defer to the wishes of the family. In some cultures, you have to wait for the life-support machine to automatically time out: in other cultures you have to wait for the family to say goodbye: in other cultures you have to wait for the death sentence to be carried out. Having said that, scheduled 1AM surgery is more common in the USA than it is in AUS. In the USA, medical care is rationed by insurance availability and coverage: it makes economic sense to utilize surgery suites continuously. In Aus, for cultural/political reasons, it is common to over-build / under-utilize surgical suites. ---
**Author:** ![doorhinge](https://avatars.discourse-cdn.com/v4/letter/d/a5b964/32.png) [@doorhinge](https://boards.straightdope.com/u/doorhinge)\ **Post date:** [December 31, 2018, 4:42am UTC](https://boards.straightdope.com/t/why-might-major-surgery-be-scheduled-in-the-middle-of-the-night/826836/29 "2018-12-31T04:42:37Z")
> [@JB99](#): > > I’ve often heard this same thing. Apparently surgical outcomes are measurably worse after lunch because the doctors are become fatigued and their circadian rhythm is naturally dropping. I’ve also heard the death rate spikes in the summer, because that’s when the new graduates are starting. > [@JB99](#): > > So Duke University’s study is a work of fiction? > > [Why You Should Avoid Afternoon Surgery](https://articles.mercola.com/sites/articles/archive/2013/01/10/amp/afternoon-surgery.aspx) > > The fact that errors/mistakes/misjudgments get reported has nothing whatsoever to do with the question of how or when they happen. But I’m sure those highly trained, highly motivated teams of surgeons are just wasting their money on malpractice insurance because they never make mistakes… > > [When Surgeons Cut the Wrong Body Part - The New York Times](https://well.blogs.nytimes.com/2007/11/28/when-surgeons-cut-the-wrong-body-part/) > [https://www.nytimes.com/1995/09/17/us/doctor-who-cut-off-wrong-leg-is-defended-by-colleagues.html](https://www.nytimes.com/1995/09/17/us/doctor-who-cut-off-wrong-leg-is-defended-by-colleagues.html) > > … like going to medical school for eight years without learning the difference between right and left. It doesn’t appear that this paper by Mercola, which mentions some study conducted by some Duke University researchers, covers your previous claim regarding surgeries performed after eating lunch, or those performed by new graduates (aka residents). Having malpractice insurance is a requirement for surgeons before they are allowed to a hospitals surgical facilities because mistakes do happen. ---
**Author:** ![nearwildheaven](https://avatars.discourse-cdn.com/v4/letter/n/90db22/32.png) [@nearwildheaven](https://boards.straightdope.com/u/nearwildheaven)\ **Post date:** [December 31, 2018, 4:49am UTC](https://boards.straightdope.com/t/why-might-major-surgery-be-scheduled-in-the-middle-of-the-night/826836/30 "2018-12-31T04:49:22Z")
> [@Dewey\_Finn](#): > > The transplant team might have known for several days that a compatible organ was in a person near death but it wasn’t until Sunday that the donor passed. Many factors enter into this. I know from my own experience with Gift of Hope patients that they may be kept “alive” for as long as two days after brain death was determined, for any number of reasons. These patients have the most complicated treatment protocols I’ve ever seen. ---
**Author:** ![Jackmannii](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/jackmannii/32/311_2.png) [@Jackmannii](https://boards.straightdope.com/u/Jackmannii)\ **Post date:** [December 31, 2018, 4:12pm UTC](https://boards.straightdope.com/t/why-might-major-surgery-be-scheduled-in-the-middle-of-the-night/826836/31 "2018-12-31T16:12:33Z")
> [@JB99](#): > > So Duke University’s study is a work of fiction? > > [Why You Should Avoid Afternoon Surgery](https://articles.mercola.com/sites/articles/archive/2013/01/10/amp/afternoon-surgery.aspx) The Duke study is not a work of fiction, but it’s worth mentioning that most of the information appearing on Joe Mercola’s quackery-laden website can be treated as fiction. While **JB99** ’s link is fairly straightforward as regards the Duke paper, it also includes a harangue against “the medical system” by Andrew Saul, who promotes the idea that serious diseases can be avoided by megavitamin supplementation (i.e. loads of vitamin C). He’s identified as “Dr. Andrew Saul” but is actually a naturopath and not an M.D. As for a greater risk of complications/mistakes occurring in July when the new residents come on staff, I think that’s more a function of in-hospital care after surgery, rather than what goes on inside the O.R. (for example, overworked new trainees being called on to make medication decisions in the middle of the night). I am somewhat prejudiced against the idea of being a patient in a university teaching hospital for this reason, though that’s also a function of not wanting to be poked at and interviewed by multiple layers of docs/docs-in-training from med students on up through residents/fellows and attendings. They’ve got to learn, but not necessarily on me. 🙂 ---
**Author:** ![brossa](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/brossa/32/3040_2.png) [@brossa](https://boards.straightdope.com/u/brossa)\ **Post date:** [December 31, 2018, 5:43pm UTC](https://boards.straightdope.com/t/why-might-major-surgery-be-scheduled-in-the-middle-of-the-night/826836/32 "2018-12-31T17:43:20Z")
It should be noted that the adverse events that made time-of-surgery significant in the Duke study were postop nausea and poorer pain control. With those two effects removed, the time of surgery was no longer a significant predictor of adverse patient events. The study did also show that as the day wears on, delays in having a room ready and other admin-type stuff do accumulate, as one would expect since you can’t predict with certainty how long each scheduled surgery will last. The postop nausea and pain control effects suggest that it is a patient issue, since presumably the anesthesiologists don’t forget how to treat nausea after 1 PM; perhaps afternoon patients have been NPO for longer (or shorter), or what have you. There have been a lot of studies of the effect of surgical scheduling/surgeon fatigue/change of shift, etc. on patient outcomes in a number of regimes - anesthesiology, neurosurgery, cardiothoracic surgery, general surgery, transplantation - with varying results. Compare [here](https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=3&ved=2ahUKEwjQ2rjGxsrfAhXSna0KHURCDLcQFjACegQIAhAB&url=https%3A%2F%2Fwww.jcvaonline.com%2Farticle%2FS1053-0770(16)30351-2%2Fpdf&usg=AOvVaw119ClUhgbTQJq_OPZlF2Tw) with [here](https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=4&cad=rja&uact=8&ved=2ahUKEwjQ2rjGxsrfAhXSna0KHURCDLcQFjADegQIBxAB&url=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4630095%2F&usg=AOvVaw0SztEzHthMk5aNdqd4ffNT), for example. Both articles have lots of references to other studies. ---
**Author:** ![ThelmaLou](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/thelmalou/32/390_2.png) [@ThelmaLou](https://boards.straightdope.com/u/ThelmaLou)\ **Post date:** [December 31, 2018, 6:17pm UTC](https://boards.straightdope.com/t/why-might-major-surgery-be-scheduled-in-the-middle-of-the-night/826836/33 "2018-12-31T18:17:27Z")
> [@aceplace57](#): > > My mom is a retired nurse anesthetist, CRNA. She went into work every morning at 5:45 AM. They had the first patient on the table by 6:45. She got home by 4 if she was lucky. Sometimes it was 6 or later. > > She did that for 30 years. Mom did eye surgery exclusively for six years before retirement. The opthalmologist liked to start at 6AM. So she got there at 5:15AM. But they always finished by noon and she came home. The opthalmologist saw patients in the afternoon. > > Mom covered call and handled cases at night. But they were considered emergencies. God bless your mom. ---
**Author:** ![bardos](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/bardos/32/1069_2.png) [@bardos](https://boards.straightdope.com/u/bardos)\ **Post date:** [December 31, 2018, 6:37pm UTC](https://boards.straightdope.com/t/why-might-major-surgery-be-scheduled-in-the-middle-of-the-night/826836/34 "2018-12-31T18:37:01Z")
Side question related, I hope permissible… do heart transplants cost upwards of $1 million? Do the medications taken for life afterwards cost around $2600 per month? ---
**Author:** ![Melbourne](https://avatars.discourse-cdn.com/v4/letter/m/b5e925/32.png) [@Melbourne](https://boards.straightdope.com/u/Melbourne)\ **Post date:** [December 31, 2018, 9:43pm UTC](https://boards.straightdope.com/t/why-might-major-surgery-be-scheduled-in-the-middle-of-the-night/826836/35 "2018-12-31T21:43:27Z")
> [@Jackmannii](#): > > As for a greater risk of complications/mistakes occurring in July when the new residents come on staff, I think that’s more a function of in-hospital care after surgery, rather than what goes on inside the O.R. (for example, overworked new trainees being called on to make medication decisions in the middle of the night). I am somewhat prejudiced against the idea of being a patient in a university teaching hospital for this reason, though that’s also a function of not wanting to be poked at and interviewed by multiple layers of docs/docs-in-training from med students on up through residents/fellows and attendings. > > They’ve got to learn, but not necessarily on me. 🙂 As I recall, in some study best care at the date when new residents came on staff, and were closely supervised by senior staff. I don’t remember where I saw that. What’s the date on the Duke study? Not sure about the effect of “medication decisions in the middle of the night”. I’d be more worried about nursing decisions in the middle of the night. In AUS, best medical specialist care still in public teaching hospitals: best nursing care perhaps in private hospitals, best hospitality definitely in private hospitals. In my limited exposure to public teaching hospitals here, never was poked or prodded by medical students. Only in my own home, and after a while, that did get old. ---
**Author:** ![KarlGauss](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/karlgauss/32/3713_2.png) [@KarlGauss](https://boards.straightdope.com/u/KarlGauss)\ **Post date:** [December 31, 2018, 10:09pm UTC](https://boards.straightdope.com/t/why-might-major-surgery-be-scheduled-in-the-middle-of-the-night/826836/36 "2018-12-31T22:09:00Z")
> [@Melbourne](#): > > . . . In AUS, best medical specialist care still in public teaching hospitals: . . . I believe that is a universal phenomenon, or at least true in much of the ‘English-speaking World’. AFAIK, lengths of stay are actually shorter, costs lower, and meaningful outcomes better in teaching hospitals\* Or once were - I’m referring to data that’s 15 years old, or more! \*with all the usual caveats about comparing patients, procedures, etc., among hospitals and providers. ---
**Author:** ![nearwildheaven](https://avatars.discourse-cdn.com/v4/letter/n/90db22/32.png) [@nearwildheaven](https://boards.straightdope.com/u/nearwildheaven)\ **Post date:** [January 1, 2019, 12:26am UTC](https://boards.straightdope.com/t/why-might-major-surgery-be-scheduled-in-the-middle-of-the-night/826836/37 "2019-01-01T00:26:30Z")
> [@bardos](#): > > Side question related, I hope permissible… do heart transplants cost upwards of $1 million? Do the medications taken for life afterwards cost around $2600 per month? The costs are widely variable, depending on other medical conditions and which medications people are on; they’re not the same for everybody. Heart transplant patients are often hospitalized for extended periods of time before they get their transplant, which also boosts the potential cost. Many of them are just too ill to be at home, and some may even have various pumping devices, up to and including an artificial heart, before they get their transplant. The first artificial heart patient was in 1982, and we STILL haven’t figured out how to use them as anything other than a transplant bridge. Why this is so is continues to puzzle researchers. ---
**Author:** ![kaylasdad99](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/kaylasdad99/32/3398_2.png) [@kaylasdad99](https://boards.straightdope.com/u/kaylasdad99)\ **Post date:** [January 1, 2019, 3:06am UTC](https://boards.straightdope.com/t/why-might-major-surgery-be-scheduled-in-the-middle-of-the-night/826836/38 "2019-01-01T03:06:57Z")
> [@Jackmannii](#): > > The Duke study is not a work of fiction, but it’s worth mentioning that most of the information appearing on Joe Mercola’s quackery-laden website can be treated as fiction. > > While **JB99** ’s link is fairly straightforward as regards the Duke paper, it also includes a harangue against “the medical system” by Andrew Saul, who promotes the idea that serious diseases can be avoided by megavitamin supplementation (i.e. loads of vitamin C). He’s identified as “Dr. Andrew Saul” but is actually a naturopath and not an M.D. > > As for a greater risk of complications/mistakes occurring in July when the new residents come on staff, I think that’s more a function of in-hospital care after surgery, rather than what goes on inside the O.R. (for example, overworked new trainees being called on to make medication decisions in the middle of the night). I am somewhat prejudiced against the idea of being a patient in a university teaching hospital for this reason, though that’s also a function of not wanting to be poked at and interviewed by multiple layers of docs/docs-in-training from med students on up through residents/fellows and attendings. > > They’ve got to learn, but not necessarily on me. 🙂 You’re a pediatrician, though, aren’t you? Rather than submitting to a poke-prod session, why don’t you just offer to discuss some material they might need help with that falls within your area of expertise? 😃 ---
**Author:** ![Mama\_Zappa](https://avatars.discourse-cdn.com/v4/letter/m/71e660/32.png) [@Mama\_Zappa](https://boards.straightdope.com/u/Mama_Zappa)\ **Post date:** [January 4, 2019, 3:45am UTC](https://boards.straightdope.com/t/why-might-major-surgery-be-scheduled-in-the-middle-of-the-night/826836/39 "2019-01-04T03:45:52Z")
> [@Jackmannii](#): > > As noted, I think the answer lies in the limited amount of time a heart can be kept viable before it needs to be transplanted (up to 12 hours according to [this article](https://tonic.vice.com/en_us/article/zmv853/exactly-what-happens-when-an-organ-donor-dies)). > > For elective surgery, I would personally recommend that people try to be scheduled early in the day (like 8 a.m. or so). You don’t want to be a surgeon’s 4th or 5th prostatectomy of the day, being operated on by a weary crew. Nor do you want to have brain surgery for a tumor in the evening, when all but one pathologist has gone home for the day and intradepartmental consults are not available for frozen sections…but that’s a separate peeve. Not only the fatigue factor, but the simple math of “surgeries take longer” and “emergencies happen”. When I needed to send my gallbladder to a better place, I was initially offered a slot at 1 PM. I said “no thanks” and waited for a much earlier slot (8 AM or so) a few weeks later and even THAT was delayed a bit. When my husband had sinus surgery, he was scheduled for 2 PM or so, he actually went back around 4 - and by the time he was done it was 5, he was the only patient in the recovery area, and I felt like they booted us earlier than he was ready because they wanted to go home. Hell, when he had knee surgery last March, his procedure was something like 11 AM when all was said and done, and he was the last person in the recovery area. A later slot also means a hellish trip home during afternoon rush, if it’s same-day surgery (and a miserable trip home for your loved ones if you’re staying) - we were driving home by 3 PM after the knee surgery and the poor guy did NOT enjoy the trip. Oh - and you know you have to fast after midnight, no matter whether your surgery is at 6 AM or 5 PM. So all in all, of COURSE you want to schedule the surgery as early in the day as possible. I had my two eye surgeries last month at 7:00 and 7:45 respectively. Getting there that early sucked. Being home by 8:00 and 9:00 respectively was niiiice. [Previous page](https://boards.straightdope.com/t/why-might-major-surgery-be-scheduled-in-the-middle-of-the-night/826836.md?page=1)