Abstract
Sleep deprivation and disruption of the circadian rhythms could impair individual surgical performance and decision making. For this purpose, this study identified potential confounding factors on surgical renal transplant patient outcomes during day and night. Our retrospective cohort study of 215 adult renal cadaver transplant recipients, of which 132 recipients were allocated in the “day-time” group and 83 recipients in the “night-time” group, primarily stratified the patients into two cohorts, depending on the start time. Within a 24 h operational system, “day-time” was considered as being from 8 a.m. to 8 p.m. and “night-time” from 8 p.m. to 8 a.m.. Primary outcomes examined patient and graft survival after three months and one year. Secondary outcomes included the presence of acute rejection (AR) and delayed graft function (DGF), as well as the rate of postoperative complications. In log-rank testing, “day-time” surgery was associated with a significantly higher risk of patient death (p = 0.003), whereas long-term graft survival was unaffected by the operative time of day. The mean cold ischemia time (CIT), which was 12.4 ± 5.3 h in the “night-time” group, was significantly longer compared to 10.7 ± 3.6 for those during the day (p = 0.01). We observed that “night-time” kidney recipients experienced more wound complications. From our single-centre data, we conclude that night-time kidney transplantation does not increase the risk of adverse events or predispose the patient to a worse outcome. Nevertheless, further research is required to explore the effect of fatigue on nocturnal surgical performance.
Highlights
Kidney transplant outcomes have improved in recent years through novel technical approaches and immunosuppressive therapy [1,2,3,4]
The two groups were similar with respect to most of the baseline characteristics, except for the higher distribution of male donors for the “day-time” group (p = 0.05)
The mean cold ischemia time (CIT) was 12.4 ± 5.3 h in the “night-time” group compared with 10.7 ± 3.6 for the “day-time” cohort (p = 0.01)
Summary
Kidney transplant outcomes have improved in recent years through novel technical approaches and immunosuppressive therapy [1,2,3,4]. A number of studies demonstrated that operative outcomes were not related to sleep deprivation [16,17,18], whereas others link mental fatigue to surgical complication rates after general procedures [19]; and mortality after liver transplants [20]. The literature regarding the impact of night-time surgery on outcomes after kidney transplantation is underrepresented and recent studies have reported conflicting results [21,22,23,24]. For this purpose, we conducted a retrospective cohort study to examine the association between the time of day of transplantation surgery (night-time vs day-time) on surgical renal transplant patient outcomes. That renal transplantation surgery performed during the night-time would have inferior outcomes compared to those performed during the day
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