Starting late does not increase the risk of post-operative complications in patients undergoing common general surgical procedures

Background There is a paucity of evidence surrounding the issue of delays on the day of surgery with respect to both causes and consequences. We sought to determine whether patients whose operations started late were at increased risk of post-operative complications. Methods We conducted a retrospective cohort study of 1420 first-of-the-day common general surgical procedures, dividing these into on-time start (OTS) and late-start (LS) cases. Our primary outcomes were minor and major complication rate; our secondary objective was to identify factors predicting LS. Groups were compared using univariable and multivariable analysis. Results LS rate was 55.3%. On univariable analysis, LS had higher rates of major and minor complications (7.3% vs. 3.5%, p = 0.002; 3.8% vs. 1.6%, p = 0.011). On multivariable analysis, LS was not associated with increased odds of any complications. Minor complications were predicted by operative duration [OR = 1.005 (1.002-1.008)], female sex [OR = 1.78 (1.037-3.061)], and undergoing an ileostomy closure procedure [OR = 10.60 (2.791-40.246)], and were reduced in those undergoing surgery on Wednesdays [OR = 0.38 (0.166-0.876)]. Major complications were predicted by operative duration [OR = 1.007 (1.003-1.011)] and ASA class [OR = 6.73 (1.505-30.109)]. Multivariable analysis using LS as an outcome identified that anesthesia time [OR = 1.35 (1.031-1.403)], insulin-dependent diabetes [OR = 1.91 (1.128-3.246)], and dyspnea upon moderate exertion [OR = 2.52 (1.423-4.522)] were predictive of LS. Conclusions Most cases in our study started late. While this has significant efficiency and economic costs, it is not associated with adverse patient outcomes. This topic remains incompletely described. Further research is needed to improve efficiency and patient experience by investigating the causes of operative delays.

Automated summary

The study found that most surgeries experienced delays, but this did not lead to adverse outcomes for patients. Further research is needed to improve surgical efficiency and patient experience.