• Rodney A Gabriel, Alison M A'Court, Ulrich H Schmidt, Richard P Dutton, and Richard D Urman.
• Department of Anesthesiology, University of California, San Diego, San Diego, CA, USA; Department of Biomedical Informatics, University of California, San Diego, San Diego, CA, USA.
• J Clin Anesth. 2018 May 1; 46: 85-90.

Study ObjectiveThere is a lack of large, multi-institutional studies analyzing the association of timing of emergency surgery with death occurring either intraoperatively or in the recovery room setting. The primary objective of this study was to determine if time of day for emergency surgeries was associated with mortality.DesignRetrospective analysis.SettingU.S. healthcare facilities.PatientsAdult patients undergoing emergency surgery and general anesthesia.InterventionsNo intervention.MeasurementsUtilizing the National Anesthesia Clinical Outcomes Registry database, all emergency non-cardiac, non-obstetric surgeries undergoing general anesthesia occurring between 2010 and 2015 in the United States were identified. We performed mixed effects logistic regression to determine the effect of time of day with mortality occurring during the intraoperative and immediate postoperative period.Main ResultsThere were 46,196 cases that were eligible for this analysis, in which 24,247 and 21,949 occurred during day and after-hours shifts, respectively. The overall morality rate was 0.28%. Mortality rates were 0.17% and 0.41% in the day and after-hour shifts, respectively. There was no statistically significant association of time of day with mortality (odds ratio 1.31, 95% CI 0.90-1.92, p = 0.16). American Society of Anesthesiologists physical status classification, age, and operative body part were all associated with mortality.ConclusionsAlthough, theoretically, health care providers working after-hour shifts may be impacted by sleep deprivation and/or limited resources, we found that time of day was not associated with increased risk of mortality during the intraoperative and immediate postoperative period in emergency surgery.Copyright © 2018 Elsevier Inc. All rights reserved.

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