fatigue

Time not a factor in some transplants

JOHNS HOPKINS U. (US) — Unlike other surgeries, patients receiving heart or lung transplants fare just as well whether their last-second surgery occurs during the day or at night.

“We aren’t suggesting that fatigue is good,” says Ashish S. Shah, assistant professor of surgery at  Johns Hopkins University and the study’s lead author. “But what is important is that, at least in this specialty, it seems we’re able to deal with it without subjecting the patient to risk.”

The research, reported in the Journal of the American Medical Association, includes more than 27,000 heart and lung transplants over 10 years at medical centers across the United States.

“This is one of the first papers to suggest that fatigue, sleep deprivation and odd hours really don’t hurt the patient. It’s a surprising finding,” Shah says. “Other papers have suggested patients are at risk if they are treated at night. For patients undergoing heart and lung transplants, everything is fine—regardless of the hour, our study shows.”

Heart and lung transplants are done as soon as scarce organs become available, without regard for the clock or how much work a surgeon has already done that day.

Researchers have long worked to identify factors that contribute to medical errors; attention has focused especially on medical staff fatigue associated with care outside of daytime hours.

Several previous studies have linked nighttime care with worse outcomes. One found that nighttime cardiac arrests were associated with lower survival and unfavorable neurological outcomes. Another found that urgent orthopedic surgery at night was linked to a higher rate of unplanned reoperation. A third found that nighttime kidney transplantation was associated with higher risk of graft failure and the need for more emergency reoperation.

Shah says it would not have surprised the researchers to find the same issues with heart and lung transplants, especially with the complication of postoperative bleeding not uncommon after complex cardiac surgery.

Theoretically, surgeon fatigue could lead to careless technique, resulting in additional bleeding requiring reoperation, or it could increase the tendency to overlook surgical bleeding. But the study found that the rate of reoperation and the length of hospital stay were the same regardless of operative time of the day.

The researchers reviewed United Network of Organ Sharing (UNOS) data on all adult heart and lung transplants in the United States between January 2000 and June 2010. Of the 16,573 heart transplants, half were done during the day and half at night.

After one year, the survival rate for heart transplants was 88 percent for daytime recipients and 87.7 percent for those who got their new hearts at night. Successful heart transplants can take as many as five to 10 hours to complete.

Of 10,545 lung transplants, roughly half were done during the day and half at night. After one year, 83.8 percent of those who got their organs during the day were still alive, compared to 82.6 percent of those who had their surgeries at night.

More news from Johns Hopkins University: http://releases.jhu.edu/

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