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Transplant Surgery No Riskier at Night: Study

TUESDAY, May 31 (HealthDay News) -- Surgeon fatigue has been blamed for adverse outcomes among patients operated on at night, but new research finds that time of day has no effect on the survival rates of patients undergoing heart and lung transplants.

"We aren't suggesting that fatigue is good," said the study's lead author, Dr. Ashish S. Shah, an assistant professor of surgery at the Johns Hopkins University School of Medicine, in a university news release. "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 study, published June 1 in the Journal of the American Medical Association, compiled data on a decade of transplants across the United States involving a total of 27,118 patients. Researchers found survival rates up to one year after surgery were similar regardless of when the organ transplants were performed -- day or night.

Although researchers noted there was a slightly higher rate of airway dehiscence (a surgical complication) associated with nighttime lung transplants, total hospital length of stay was similar no matter what time of day surgeons operated.

The study's authors concluded that experienced transplant teams have probably found effective ways to cope with and overcome fatigue and emotional stress in order to do their jobs well. "It is likely that because urgent nighttime operations are common in all types of transplant surgery, health care personnel involved in the transplant have developed various systems to prevent errors and directly cope with the limitations associated with nighttime medical care," they wrote in the news release.

The researchers also argued that surgeons from other specialties could reduce adverse patient outcomes by copying the strategies and coping techniques used by heart and lung transplant teams.

"The authors provide us with firm evidence that even highly complex procedures can be performed safely and with good results at any time during the day," said Dr. Ernesto P. Molmenti, vice chairman of surgery and director of the transplant program at the North Shore-LIJ Health System in Manhasset, N.Y., who was not involved in the study.

"We should consider the performance quality guidelines of cardiothoracic transplant centers as a way to improve other medical and surgical outcomes," Molmenti concluded.

More information

The U.S. National Institutes of Health provides more information on heart transplant survival rates.

-- Mary Elizabeth Dallas

SOURCE: Ernesto P. Molmenti, M.D., vice chairman of surgery and director, transplant program, North Shore-LIJ Health System in Manhasset, N.Y.; Johns Hopkins Medicine, news release, May 31, 2011.

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