Is after-hours free-flap surgery associated with adverse outcomes?

SummaryPurposeRecently, there has been increasing interest in system-based approaches to improve patient safety, including the concern of the risks of after-hours surgery. Although several studies have demonstrated worse outcomes associated with night surgery, little is known regarding the effects of after-hours surgery on microsurgery fields. Here, we evaluated the hypothesis that after-hours microsurgery could increase the risk of postoperative complications.MethodsA retrospective case–control study was performed of patients who underwent elective microsurgical reconstruction between January 2004 and March 2012. Patients were categorised into an after-hours group defined as an operation starting between 4 pm and 7 am or a daytime group defined as an operation starting between 7 am and 4 pm.ResultsA total of 454 patients were included, with 345 patients in the daytime group and 109 patients in the after-hours group. Flap-compromised complications were observed in 24 patients (5.3%), including 13 (2.9%) total losses and 11 (2.4%) partial losses. After-hours surgery was associated with a higher risk of total flap loss (p = 0.011) and re-exploration (p = 0.004), which remained significant in multivariate analysis (p = 0.018; p = 0.002). Total flap salvage was possible in 18 of 31 (58.1%) of re-explorations, and a significantly higher success rate was observed in the daytime group (p = 0.027). Total length of hospital stay was significantly longer in the after-hours group (p = 0.039). Minor complication rates did not show significant differences between the groups.ConclusionsAfter-hours performance of elective free flap surgery was demonstrated to be associated with increased risk of flap-related complications.