Study of Studies July/August 2013

The Worst Time to Have Surgery

By the month, day, and hour
Clock: Michael A. Keller/Corbis; Scalpel: Ocean/Corbis

“Touch not with iron that part of the body ruled by the sign the moon is transiting,” commanded an ancient medical-astrology tract. Meaning, since Taurus rules the neck and throat, you should not get a cyst removed from your neck when the moon is in Taurus. Likewise, no hysterectomies when the moon is in Scorpio (the ruler of sex organs).

We don’t talk much about lunar cycles in the average doctor’s office today, but this doesn’t mean timing is irrelevant in modern medicine.

According to one bit of popular lore, you should avoid being hospitalized in July, when that year’s graduating medical students begin working as residents. Every physician has to have a first day, but in the U.S. system, July 1 is everyone’s first day. Could this confluence of rookie doctors mean more medical errors? Researchers at Johns Hopkins reviewed almost 3,000 surgeries for spinal metastases and found a higher rate of complications during July surgeries, as well as a higher mortality rate [1]. Still, other studies have found that surgical outcomes are no worse in July than in any other month, perhaps due to increased vigilance by senior doctors [2].

Which is not to say that the calendar doesn’t make a difference: people admitted to the hospital on an emergency basis on public holidays are, compared with patients admitted on non-holidays, 48 percent more likely to be dead one week later [3]. The clock matters, too: with each hour that passes on a given day of performing colonoscopies, the average gastroenterologist is 4.6 percent less likely to detect a colon polyp [4]. Similarly, in a study of surgeries at Duke University Medical Center, the likelihood of problems related to anesthesia increased from a low of 1 percent during surgeries starting at 9 a.m. to a high of 4.2 percent for those starting at 4 p.m., possibly because practitioners grew tired over the course of the day [5].

Timing might even influence whether you have surgery: the economist H. Shelton Brown III once described a “rush hour effect,” whereby women in labor were more likely to have an unplanned C‑section on Friday between 3 and 9 p.m.—perhaps, he suggested, doctors were interested in getting things wrapped up before the weekend (those “things” being infants) [6]. Night is not the ideal time to be in labor, either. One California study found a 25 percent greater risk of neonatal death following nighttime deliveries. Some of that increased risk could have been because nighttime hospitalizations disproportionately involve emergencies and other complications. But even controlling for such factors, infant death was 16 percent more likely following a late-night birth [7].

Medical researchers don’t do these sorts of studies to inform medical consumers so much as to identify the causes of medical errors, with an eye toward prevention. Still, now you know: early to bed, early to get the best colonoscopies and surgeries; and stay safely in your home, motionless, on public holidays.

The Studies:

[1] Dasenbrock et al., “The Impact of July Hospital Admission on Outcome After Surgery for Spinal Metastases at Academic Medical Centers in the United States, 2005 to 2008” (Cancer, 2012)

[2] McDonald et al., “The Effect of July Admission on Inpatient Outcomes Following Spinal Surgery” (Journal of Neurosurgery: Spine, 2013)

[3] Smith et al., “Emergency Medical Admissions, Deaths at Weekends and the Public Holiday Effect. Cohort Study” (Emergency Medicine Journal, 2012)

[4] Lee et al., “Queue Position in the Endoscopic Schedule Impacts Effectiveness of Colonoscopy” (The American Journal of Gastroenterology, 2011)

[5] Wright et al., “Time of Day Effects on the Incidence of Anesthetic Adverse Events” (Quality and Safety in Health Care, 2006)

[6] Brown, “Physician Demand for Leisure: Implications for Cesarean Section Rates” (Journal of Health Economics, 1996)

[7] Gould et al., “Time of Birth and the Risk of Neonatal Death” (Obstetrics and Gynecology, 2005)

Presented by

James Hamblin, MD, is a senior editor at The Atlantic. He writes the health column for the monthly magazine and hosts the video series If Our Bodies Could Talk.

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