Why You Should Avoid Afternoon Surgery
January 10, 2013
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By Dr. Mercola
If you are scheduling a surgery, you probably put some thought to the procedure itself, the surgeon who will perform the procedure and, hopefully, which hospital to go to.
But if you didn't pay much attention to the time of day your surgery is scheduled, you could be missing out on a very simple and free, yet crucially important variable in your outcome …
Patients Undergoing Afternoon Surgery May Fare Worse
A study conducted by Duke University researchers found that adverse events related to surgical anesthesia were more frequent for surgeries started between 3 pm and 4 pm than they were for those that began early in the morning, at 7 am.1
After analyzing more than 90,000 surgeries, researchers found that adverse events such as nausea, vomiting and postoperative pain were more common in the afternoon surgeries.
Among adverse events categorized as "other," which included potentially dangerous changes in blood pressure and operating room equipment problems, along with problems related to pain medication and pain management through anesthetic techniques, the predicted probability of one occurring rose from 1 percent at 9 am to over 4 percent at 4 pm.
There were other problems with afternoon surgeries too, including an increased likelihood of administrative delays, such as waiting for laboratory test results, doctors running late, transporters not being available to move patients and rooms not being ready on time, all of which have the potential to ultimately increase adverse events as well.
Fatigue, Circadian Rhythms and Shift Changes May be to Blame
As for why the afternoon may prove to be a more dangerous time for surgery, there are likely several factors involved. Among them:2
- Circadian rhythm: The natural circadian rhythm, which governs sleep, brain activity and other bodily functions, dips between 3 pm and 5 pm, which may make it harder for health care professionals to stay on top of complex tasks, such as administering anesthesia.
- Fatigue: Many health care workers start their days early and end their shifts right around 3 pm. This end-of-the-day fatigue, or simply their eagerness to get home, could impact their performance on the job.
- Shift Changes: Anesthesia care teams often change shifts around 4 pm to 6 pm. This means you may end up with different people caring for you from the start to finish of your surgery. While essential information should be transferred between teams during the shift change, it's a prime situation for mishaps to occur.
Weekends, The Month of July Also Better Off Avoided
What's my personal recommendation when it comes to hospital stays? Naturally, my number one suggestion is to avoid hospitals unless it's an absolute emergency and you need life-saving medical attention. If you're having an elective medical procedure done, remember that this gives you greater leeway and personal choice—use it!
Many believe training hospitals will provide them with the latest and greatest care, but they can actually be more dangerous. As a general rule, avoid elective surgeries and procedures during the month of July because this is when brand new residents begin their training.
According to a 2010 report in the Journal of General Internal Medicine, lethal medication errors consistently spike by about 10 percent each July, particularly in teaching hospitals, due to the inexperience of new residents.3 Also be cautious of weekends.
Every Hospital Stay Poses a Risk …
Dr. Andrew Saul, co-author of Hospitals and Health: Your Orthomolecular Guide to a Shorter Hospital Stay (which is available on Amazon), explained that the lowest estimate makes hospitals one of the top 10 causes of deaths in the United States ... and the highest estimate makes hospital and drugs the number one cause of death in the United States. Some of the top 10, and most lethal, medical mishaps are mistakes that should be extremely rare, but happen with shocking regularity:
1. Preventable Adverse Drug Reactions
An estimated 450,000 preventable medication-related adverse events of mostly correctly prescribed drugs occur in the U.S. every year. A large part of the problem is simply because so many drugs are used and prescribed – and many patients receive multiple prescriptions at varying strengths, some of which may counteract each other or cause more severe reactions when combined. Dosage errors, medication mix-ups and even giving the wrong medication to the wrong person are all too common.
2. Avoidable Infections
Hospital-acquired infections are alarmingly common, and sadly they're often deadly. In the United States, more than 2 million people are affected by hospital-acquired infections each year, and a whopping 100,000 people die as a result. According to the 2011 Health Grades Hospital Quality in America report,4 analysis of approximately 40 million Medicare patients' records from 2007 through 2009 showed that 1 in 9 patients developed such hospital-acquired infections!
The saddest part is, most of these cases could likely have been easily prevented with better infection control in hospitals – simple routines such as doctors and nurses washing their hands between each patient, for example.
3. Surgical Souvenirs
Surgical tools or other objects are left inside people after surgery far more often than you'd like to think. This is often the result of surgical staff failing to count, or miscounting, equipment during the procedure. Unexpected pain, fever and swelling after surgery are all indications that you could have a surgical tool or piece of a tool still inside you.
Just how often does this occur? One study in the New England Journal of Medicine found that about 1,500 Americans have objects left inside of them following surgery every year.5
Remember to Claim Your Power If You're Admitted to the Hospital
One of the reasons I am so passionate about sharing the information on this site about healthy eating, exercise, and stress management with you is because it can help keep you OUT of the hospital.
Please be proactive and start pursuing a healthy lifestyle today so you don't become a victim of the medical system. I have compiled my best tips in a customized 100-page report on how you can Take Control of Your Health. It is customized to three different levels and you can start at any level, but be sure and read from the beginning, as reviewing the basics is the best way to reinforce healthy patterns.
Now, if you do have to go into a hospital for surgery or any other procedure, you need to know how to play the "game." In my recent interview (above) with Dr. Saul, he shared potentially life-saving tips in the event you find yourself in a hospital.
It's worth taking Dr. Saul's recommendation to bring a personal advocate -- a relative or friend who can speak up for you and ensure you're given proper care if you can't do so yourself. But also understand that you, the patient, are the most powerful entity within the entire hospital system. However, the system works on the assumption that the patient will not claim that power. Knowing your rights and responsibilities can help ensure your hospital stay is a safe and healing one.
"The most important thing to remember is this: the hospital power structure," Dr. Saul says. "No matter what hospital you go in… the question is, 'Are you going to walk out the front door, or be wheeled out the back?'
Now, here's what people need to do. They need to understand that when they are faced with hospitalization, the most powerful person in the most entire hospital system is the patient. … A patient can say, 'No. Do not touch me.' And they can't. If they do, it's assault, and you can call the police. Now, they might say, 'Well, on your way in, you signed this form.'
You can unsign it. You can revoke your permission. Just because somebody has permission to do one thing, it doesn't mean that they have the permission to do everything. There's no such thing as a situation that you cannot reverse.
If you can make amendments to the U.S. Constitution, you can change your mind about your own personal healthcare. It concerns your very life. You don't want to cry wolf for no reason, but the patient has the potential to put a stop to anything -- absolutely anything. … It's a game, and you can win it. But you can't win it if you don't know the rules. And basically, they don't tell you the rules. In 'Hospitals and Health,' we do."
Knowing how to prevent disease so you can avoid hospitals in the first place is clearly your best bet. But knowing what to do to make your hospital stay as safe and healing as possible is equally important. For the inside scoop, I highly recommend reading Dr. Saul's book, Hospitals and Health; this is especially important if you know you're going to be facing a hospital stay, such as for a routine surgery, in the near future.