"Good Morning, Doctor. Please Put Me Under Now and Let the Cutting Begin."
Research indicates that afternoon operations are more likely to lead to adverse events related to anesthesia.
A study was recently published in Quality & Safety in Health Care. A summary of the study published at www.drkoop.com, said that "researchers analyzed more than 90,000 surgeries performed at Duke Hospital from 2000 to 2004, and categorized them according to type or severity of the adverse event. The categories were then cross-referenced with the time of the surgery. Adverse events were most common for operations starting between 3 p.m. and 4 p.m., as compared with 7 a.m. The lowest probability of having an adverse event (1 percent) was at 9 a.m. and the highest (4.2 percent) at 4 p.m."
Why is this so? " 'Patients might be more susceptible to pain in the afternoon,' [study author Dr. Melanie] Wright said.
The late-afternoon period also coincides with natural lows in the circadian rhythm, or the body's internal clock. Anesthesia care teams usually change at about 7 in the morning, and again between 4 p.m. and 6 p.m. This could be colliding with circadian low points and end-of-day fatigue.
A new concept called "chronobiology" might even be at fault. 'It is possible that people react to drugs differently at different times of the day,' said Dr. David Birnbach, director of the University of Miami's Center for Patient Safety. 'People are now looking at the effect on drugs of circadian rhythms, how long since the last cup of coffee, how many visitors, was it a quiet time or busy time,' he added.
There could also be a combination of doctor fatigue along with high caseloads and communication problems. 'We have fewer guys watching more cases. We've got tired folks handing off patients, and there's lots of room for communication problems,' Wright said.
There may also be less focus in the afternoon, as people take on more and more tasks, Lubarsky, who was working at Duke while the study was ongoing, pointed out. 'People get distracted trying to relieve colleagues, and the number of cases does indeed go up. Late afternoon meetings occasionally occur and pull you away,' he said. "
Read the entire article here.