Patients Undergoing Night-time Surgery Twice as Likely to Die

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A recent study has shown that patients operated on during the night were twice as likely to die as those undergoing daytime surgery. Daxa Patel – a Medical Negligence Partner at Simpson Millar – examines the report and comments on why hospitals need proper funding.

Patients Undergoing Night-time Surgery Twice as Likely to Die

The event: the World Congress of Anaesthesiologists; the location: Hong Kong. Here the stage was set for the findings of a key study to be announced to 9000+ delegates and the world beyond.

Those findings revealed an alarming trend, with research claiming patients who underwent surgery outside of normal working hours were more likely to die.

This broke down as:

  • Patients operated on during the night – 2.7 times more likely to die
  • Patients operated on late in the day – 1.43 times more likely to die
The research factored in patient age and ASA score – which assesses preoperative physical status – and adjusted the results accordingly.

The study was carried out by dividing the working day into 3 separate time blocks:

  • Daytime: 07.30 – 15.29
  • Evening: 15.30 – 23.29
  • Night: 23.30 – 07.29

Based on this, a retrospective analysis of 30 day postoperative deaths over the course of the previous 5 years was undertaken, resulting in the findings announced at the conference in Hong Kong.

Surgical Deaths

According to the Royal College of Surgeons (RCS) there were 4.7million surgical admissions in England over the 2013/14 period, with general surgery being the most common form of procedure. Operations make up a third of all hospital admissions, with further statistics – courtesy of a 2011 National Confidential Enquiry into Patient Outcome and Death (NCEPOD) report – revealing that less 1% of patients who have undergone some form of surgery in the UK die during the same hospital admission. The report estimates these deaths to number between 20,000 and 25,000 annually.

It goes on to say that 80% of these deaths are restricted to a small group, termed as 'high risk patients', who are defined by age, number of illnesses, amount of medications and other relevant identifiers. This classification applies to approximately 10% of the overall surgical population and, in turn, has an approximate hospital mortality rate of 10 – 15%.

In 1997, NCEPOD published its influential 'Who Operates When?' study, which looked at perioperative deaths, one of the recommendations of which was:

"All hospitals admitting emergency surgical patients must be of sufficient size to provide 24-hour operating rooms and other critical care services. There should also be sufficient medical staff to perform these functions."

In a follow-up report titled 'Who Operates When? II' a further recommendation of caution regarding unnecessary night-time surgery was made, along with the proposal that only surgery meeting its NCEPOD1 category should take place between the hours of midnight and 08.00:

  • NCEPOD1 – Emergency: Immediate lifesaving operation, resuscitation simultaneous with surgical treatment (Within 1 hour).

Respondents to a Royal College of Surgeons survey indicated that they also stopped non-life threatening surgery between 21.00 and midnight.

Underfunded Hospitals

The findings released to the World Congress of Anaesthesiologists offer a worrying insight into the problems facing publicly funded hospitals outside of what we refer to as 'regular' working hours.

The spectre of understaffing and budgetary restraints here in the UK threaten to derail plans for a 'truly 7 day NHS' with the concerns of Junior Doctors – who will be at the coalface of this 7-day revolution – along with the findings of the Department of Health's own risk register falling on deaf ears.

Daxa Patel comments:

"As the NHS struggles to meet demand its resources are spread evermore thinly, with a lack of investment leaving many departments either threatened with closure or woefully understaffed."

"Despite this, doctors, nurses, surgeons and the wealth of other healthcare professionals that keep our hospitals running are doing their best to ensure patients receive a consistent level of care."

"When this care is found wanting, medical errors can occur, which can have devastating effects for both patients and their families."

"The report that those undergoing surgery at night are twice as likely to die is worrying and clearly highlights the fact that public hospitals need proper funding to ensure patients continue to receive the same quality of care, no matter what time of day it is."


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