Surgeries Done in the P.M. Carry Added Risks

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Here’s something new to think about when you’re about to go under the surgeon’s scalpel: “What time is it?”

 Patients undergoing surgery are more likely to experience side effects when the operation is performed in the late afternoon rather than in the morning. The adverse effects are unexpected and they are related to the anesthesia used to induce a temporary state of unconsciousness.

 The news comes from a Duke University study — the side effects aren’t extreme by any means, but they are present. Plus, they are enough to make a patient wish for his/her surgery to be scheduled in the a.m. instead of the p.m. The adverse effects were increased nausea and pain, both of which were consistently higher following afternoon surgeries.

 Believing that the time of day could influence anesthesia- related effects, researchers looked at more than 90,000 operations, which had been performed at Duke Hospital from 2000 to 2004. They categorized any side effects and then cross-referenced them with the time of the surgery. That’s when they found that adverse effects were more common in surgeries that started between three and four p.m. compared to seven to nine a.m.

 The highest probability of having a side effect was at four p.m. (4.2%). The lowest: seven a.m. (one percent). The most common problems were managing pain and nausea/vomiting after surgery.

 Reasons for the “big difference” are unknown, but there are a whole lot of hypotheses. One is that patients could be more susceptible to pain in the afternoon. Also, at that time of day, our body’s natural circadian rhythm tends to be in a downswing, which means you may be more fatigued than usual, thus contributing to your experiencing side effects. There’s also “chronobiology” — the proven idea that patients will react differently to drugs at various times throughout the day. This, too, is linked to our circadian rhythm.

 Could the problem be physician fatigue? Doctors are often overworked and communication breakdowns are frequent, plus there simply may be less focus on the patient in the late afternoon. Patients are also apt to deal with administrative delays as well, such as waiting for test results and busy doctors running around afterward. This heightened nervousness can contribute to nausea and pain.

 So should you say ‘no’ to late-day surgeries? The researchers say you can’t generalize it enough to say that. But if you are confronted with an option, or a preference, it’s best to say “I’d prefer a morning surgery, please.”




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