Why might major surgery be scheduled in the middle of the night?

*transplant, not translate. DYAC

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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 was the first to demonstrate the phenomenon. The observation has since been extended by the same authors and others.

My father-in-law had bypass surgery at midnight. The surgeon said it wasn’t a big deal to do surgery that late.

yeah my gallbladder was removed at 3 am that wasn’t unusual its just when they had a open few hours ……

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 and involved a team of heart surgeons. Trauma teams typically work multiple shifts.

So Duke University’s study is a work of fiction?


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…


… like going to medical school for eight years without learning the difference between right and left.

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.

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.

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.

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. :slight_smile:

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 with here, for example. Both articles have lots of references to other studies.

God bless your mom.

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?

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.

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.

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.

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?


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.