Outcomes of Non-Emergent Cardiac Surgery After Overnight Operative Workload: A Statewide Experience

Objective Cardiac surgeons experience unpredictable overnight operative responsibilities, with variable rest prior to same-day, first-start scheduled cases. This study evaluated the frequency and impact of a surgeon’s overnight operative workload on the outcomes of their same-day, first-start operations. Methods A statewide cardiac surgery quality database was queried for adult cardiac surgical operations between 7/1/2011-3/1/2021. Non-emergent, first-start, Society of Thoracic Surgeons (STS) predicted risk of mortality operations were stratified by whether or not the surgeon performed an overnight operation that ended after midnight. A generalized mixed effect model was used to evaluate the effect of overnight operations on an STS composite outcome (five major morbidities or operative mortality) of the first-start operation. Results Of all first-start operations, 0.4% (239/56,272) had a preceding operation ending after midnight. The STS predicted risk of morbidity and mortality was similar for first-start operations whether preceded by an overnight operation or not (overnight operation: 11.3%; no overnight operation: 11.7%, p=0.42). Unadjusted rates of the primary outcome were not significantly different following an overnight operation (overnight operation: 13.4%; no overnight operation: 12.3%, p=0.59). After adjustment, overnight operations did not significantly impact the risk of major morbidity or mortality for first-start operations (ORadj: 1.1, p=0.70). Conclusions First-start cardiac operations performed following an overnight operation represent a small subset of all first-start STS predicted risk operations. Overnight operations do not significantly influence the risk of major morbidity or mortality of first-start operations, which suggests that surgeons exercise proper judgment in determining appropriate workloads.