Is evening elective surgery safe?

  • Should Elective Surgeries Be Permitted to Be Performed in the Evening? (PC10)
  • 2:20-3:20 p.m. Sunday
  • BCEC Room 257AB

In an era where quality measurements are used to grade and reimburse physicians, perioperative teams are in the spotlight if outcomes are less than optimal. One area drawing attention is elective surgeries performed late in the day, when perioperative teams could be tired and resources may be relatively scarce.

Two anesthesiologists will debate this hot topic Sunday during “Should Elective Surgeries Be Permitted to Be Performed in the Evening?

“We will debate using evidence from recent literature,” said Menachem M. Weiner, M.D. “There are a fair number of studies that have looked at whether elective surgery in the evening impacts patient safety. We will go through the main factors.”

Dr. Weiner is an Associate Professor of Anesthesiology, Perioperative and Pain Medicine at Icahn School of Medicine at Mount Sinai. He will debate Joshua A. Heller, M.D., an Assistant Professor of Anesthesiology, Perioperative and Pain Medicine at Mount Sinai West-St. Luke’s Hospital.

The factors they will explore are:

  • Fatigue, because of the assumption that surgery teams are likely to be tired late in the day
  • Reduced resources, because hospitals have smaller staffs in the evenings; when help is needed, less support is available
  • More handoffs of cases and responsibilities, because when work shifts end, new care-team members have to get up to speed

Studies about poor outcomes for surgeries late in the day make for interesting news stories, so they have been popular in non-medical publications, and patients are aware of them, Dr. Weiner said. There also has been conflict about late work hours among surgical staffs, especially among surgeons and anesthesiologists, Dr. Weiner said.

The flip side of the coin is that other studies refute the negative information about evening surgeries, he said.

“We will analyze the literature while going through the arguments to see what is true and to explain what the literature does show,” Dr. Weiner said. “We also will look at different surgeries because there may be differences in different types of surgeries. Some may be just as safe no matter what time of day they are done, and we will talk about why that might be.”

Both debaters are expected to present information from about 20 studies about various types of elective surgeries, including cardiac surgery, which has a different body of evidence, he said.

“We want everyone to come and be educated about what the evidence shows,” Dr. Weiner said. “You don’t want to just base your feelings on intuition.”

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