The impact of nighttime or weekend surgeries on survival had been previously examined in thoracic organs and kidney transplants with discordant results. Although many LT are done semielectively, organ availability and procurement determine the start time of liver transplant surgery for a significant number of patients. Successful outcome of liver transplantation (LT) depends on the active and optimal participation of a multidisciplinary team of surgeons, anesthesiologists, nurses, and technicians. 11-15 Similarly, percutaneous coronary interventional procedures done during off hours are associated with serious adverse events, including myocardial infarction and mortality. However, when such surgeries are performed at night, a higher incidence of serious complication rates has been reported with colorectal, laparoscopic, and orthopedic surgeries. 7-10 Except for emergency surgical procedures, most complex surgical procedures are done electively. Many studies have shown that patients hospitalized outside regular working hours with myocardial infarction, 1 pulmonary embolism, 2 stroke, 3 ruptured abdominal aortic aneurysm, 4 heart failure, 5 or gastrointestinal bleeding 6 have worse outcomes, but there are few conflicting reports. It has been suggested that hospitalized patients may get suboptimal care from physician during nights, weekends, or summer holidays due to sleep deprivation, fatigue, or reduced medical staffing. Our study showed that the time of transplant surgery whether done during nights, weekends, or summer months had no effect on graft or patient survival irrespective of center volume, patient, or donor risk factors. Cox regression analysis after adjusting for risk factors, including Model for End-stage Liver Diseases, donor risk index, and liver center volume, confirmed that there were no significant differences in outcomes. The graft and patient survival and complications were not influenced by the time of transplant for both HCC and non-HCC population. Results.ĭuring the study period, 4 434 (9.6%) were done in the night, 12 147 (26.4%) over weekends, and 11 976 (26%) during summer months. The independent effect of time of transplant on outcomes was analyzed after adjusting for common confounders, including Model for End-stage Liver Diseases scores and transplant center volume. Patients with hepatocellular carcinoma (HCC) were analyzed separately. The survival outcomes were estimated by Kaplan-Meier survival analysis. We estimated the start time of liver transplant surgery by utilizing the cross-clamp time and cold ischemia time (cross-clamp time + cold ischemia time – 2 h). We used United Network for Organ Sharing (UNOS) data sets of adults transplanted between February 27, 2002, and September 30, 2016. Our objective was to determine whether there were differences in outcomes when surgery was performed in the night (10 pm–6 am), on weekends (Saturday or Sunday), or during summer months (June–August). It has been suggested that hospitalized patients may get suboptimal care in nights or on weekends or summer holidays due to sleep deprivation, physician fatigue, or reduced medical staffing. The work cannot be changed in any way or used commercially without permission from the journal. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. Thuluvath, MD, FRCP, Institute of Digestive Health and Liver Diseases, Mercy Medical Center, Baltimore, MD 21202. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site ( Correspondence: Paul J. Supplemental digital content (SDC) is available for this article. The authors declare no funding or conflicts of interest. contributed to interpretation of data and critical revision of manuscript. contributed to the study concept, design, analysis, and interpretation of data. 1 Division of Gastroenterology, Institute of Digestive Health and Liver Diseases, Mercy Medical Center, Baltimore, MD.Ģ Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.ģ Department of Surgery, University of Maryland School of Medicine, Baltimore, MD.
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