Scheduling surgery earlier in the day may help prevent unexpected problems related to anesthesia, including added pain and postoperative nausea and vomiting, according to a study conducted at Duke University.
Researchers at Duke University Medical Center analyzed more than 90,000 surgeries performed at the hospital between 2000-2004. The study, which appears in the August issue of the journal Quality & Safety in Health Care, found that patients whose surgeries began around 4 p.m. were about four times more likely to request pain medication than those whose surgeries started around 9 a.m.
A direction to go
"What I think this study will do, and what it should do, is stimulate additional research," said Dr. James Hicks, of Portland, Ore., a director with the American Society of Anesthesiologists. "It will give us a direction to go."
Researchers analyzed a database maintained by the hospital that contains a record of each surgical patient's course of treatment from hospital admission to discharge, including adverse events. The researchers divided the problems they found into three categories: "error," "harm," and "other adverse events."
The 31 incidents researchers placed in the "error" category included improper dosing of patients with anesthetic agents.
Researchers deemed 667 incidents as harmful, and they ranged from prolonged sedation to an infected wound. Postoperative nausea and vomiting accounted for 35 percent of these incidents, the study said.
Researchers said there were 1,995 "other" incidents, which included potentially dangerous changes in blood pressure and problems with operating room equipment.
"On the positive side we didn't find anything that showed people were being hurt badly by this, they're manageable things," said Dr. Melanie Wright, a human factors specialist at Duke University who led the study. "But it points to something we can look at more closely: Can we improve quality care?"
Sandra Tunajek, director of the Council for Public Interest in Anesthesia, which seeks to educate patients and assist the public and practitioners on anesthesia-related issues, said the problems are largely the result of health care workers facing ever-increasing pressures in the volatile environment of operating rooms.
Assembly line mentality
"If you're tired and stressed and overworked, no matter what field your in, things can go wrong," said Tunajek, who called the study unique. "There's an assembly line kind of mentality that really just comes down to production pressure, and it's prevalent everywhere in health care, I think."
The study identified several possible reasons why there were more problems later in the day, including tired health care workers and swings in people's natural ups and downs during the day. Doctors arriving late for surgery, a lack of transporters available to move patients, and delays in completing test results were also possible sources of late-day problems, researchers said.
Researchers said they could not determine the experience level of those providing anesthesia, their case loads or the makeup of the medical team from the charts they examined. They also noted the reports of problems could be biased because they were self-reported.
The research was supported by the Anesthesia Patient Safety Foundation, which encourages studies on methods of reducing injuries from anesthesia.