Patient outcomes related to the daytime versus after-hours surgery: A meta-analysis

Background: It has been investigated in multiple subspecialties that surgery timing may have an impact on patient outcomes, yet no definitive evidence is reached. Objectives: To analyze current literature on this topic and investigate whether day versus after-hours surgery may have an effect on postoperative outcomes. Data sources: MEDLINE, EMBASE and Cochrane Library. Study eligibility criteria: Studies reporting on the surgery timing as well as postoperative mortality and morbidity were included. Participants and interventions: There were 119,213 and 46,196 surgery cases that occurred during daytime and after-hours shifts, respectively. Study appraisal and synthesis methods: Thirteen studies (12 retrospective case controls and 1 prospective study) published in English between February 2003 and May 2018 were scrutinized by two reviewers. The odds ratio (OR) for each clinical outcome data was presented with a 95% confidence interval (CI). Pooled estimates of effects were calculated using random-effect models. Results: Among the included studies, 10 reported morbidities and 10 reported death rates. The pooled OR was 0.67 (95% CI: 0.51–0.89; p = 0.005) for postoperative mortality and 0.71 (95% CI: 0.53–0.94; p = 0.02) for overall postoperative complications in patients who underwent daytime versus after-hours surgery. Conclusion: After-hours surgery was associated with significantly increased postoperative mortality and morbidity, which might be related to state of urgency, availability of resource and/or fatigue factor of the personnel.