After hours surgery is associated with greater mortality and morbidity, although underlying cause remains unclear.

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• Nuo Yang, Waleed Mohammad Elmatite, Abdelrahman Elgallad, Csaba Gajdos, Leili Pourafkari, and Nader D Nader.
• Department of Anesthesiology, University at Buffalo, Buffalo, NY, USA. Electronic address: nuoyang@buffalo.edu.
• J Clin Anesth. 2019 May 1; 54: 13-18.

BackgroundIt has been investigated in multiple subspecialties that surgery timing may have an impact on patient outcomes, yet no definitive evidence is reached.ObjectivesTo analyze current literature on this topic and investigate whether day versus after-hours surgery may have an effect on postoperative outcomes.Data SourcesMEDLINE, EMBASE and Cochrane Library.Study Eligibility CriteriaStudies reporting on the surgery timing as well as postoperative mortality and morbidity were included.Participants And InterventionsThere were 119,213 and 46,196 surgery cases that occurred during daytime and after-hours shifts, respectively.Study Appraisal And Synthesis MethodsThirteen 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.ResultsAmong 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.ConclusionAfter-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.Published by Elsevier Inc.

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