1
|
Patlin BH, Mok H, Arra M, Haspel JA. Circadian rhythms in solid organ transplantation. J Heart Lung Transplant 2024; 43:849-857. [PMID: 38310995 PMCID: PMC11070314 DOI: 10.1016/j.healun.2024.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/17/2024] [Accepted: 01/29/2024] [Indexed: 02/06/2024] Open
Abstract
Circadian rhythms are daily cycles in physiology that can affect medical interventions. This review considers how these rhythms may relate to solid organ transplantation. It begins by summarizing the mechanism for circadian rhythm generation known as the molecular clock, and basic research connecting the clock to biological activities germane to organ acceptance. Next follows a review of clinical evidence relating time of day to adverse transplantation outcomes. The concluding section discusses knowledge gaps and practical areas where applying circadian biology might improve transplantation success.
Collapse
Affiliation(s)
- Brielle H Patlin
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Huram Mok
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Monaj Arra
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Jeffrey A Haspel
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri.
| |
Collapse
|
2
|
Uhl M, Waeckel T, Seizilles De Mazancourt E, Taha F, Kaulanjan K, Goujon A, Beretta A, Papet J, Dupuis H, Panis A, Peyrottes A, Lemaire A, Larose C, Bettler L, Pues M, Joncour C, Stempfer G, Ghestem T, De Sousa P. Impact of Transplantation Timing on Renal Graft Survival Outcomes and Perioperative Complications. Transpl Int 2024; 37:12202. [PMID: 38420268 PMCID: PMC10899379 DOI: 10.3389/ti.2024.12202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 01/29/2024] [Indexed: 03/02/2024]
Abstract
Nighttime organ transplantation aims to decrease cold ischemia duration, yet conflicting data exists on its impact on graft function and perioperative complications. This multicenter TRANSPLANT'AFUF study including 2,854 patients, transplanted between 1 January 2011, and 31 December 2022, investigated nighttime kidney transplantation's impact (8:00 p.m.-8:00 a.m.) versus daytime (8:00 a.m.-8:00 p.m.) on surgical complications and graft survival. Overall, 2043 patients (71.6%) underwent daytime graft, while 811 (28.4%) underwent nighttime graft. No impact was observed of timing of graft surgery on graft survival with a median survival of 98 months and 132 months for daytime and nightime grafting, respectively (p = 0.1749). Moreover, no impact was observed on early surgical complications (Clavien I-II = 20.95% for DG and 20.10% for NG; Clavien III-IV-V = 15.42% for DG and 12.94% for NG; p = 0.0889) and late complications (>30 days) (Clavien I-II = 6.80% for DG and 5.67% for NG; Clavien III-IV-V = 12.78% for DG and 12.82% for NG; p = 0.2444). Noteworthy, we found a significant increase in Maastricht 3 donors' rates in nighttime transplantation (5.53% DG vs. 21.45% NG; p < 0.0001). In conclusion, nighttime kidney transplantation did not impact early/late surgical complications nor graft survival.
Collapse
Affiliation(s)
- M. Uhl
- Urology, Centre Hospitalo-Universitaire Amiens Picardie, Amiens, France
| | - T. Waeckel
- Urology, Centre Hospitalo-Universitaire Caen, Caen, France
| | | | - F. Taha
- Urology, Centre Hospitalo-Universitaire Reims, Reims, France
| | - K. Kaulanjan
- Urology, Centre Hospitalo-Universitaire Pointe A Pitre, Guadeloupe, Pointe à Pitre, France
| | - A. Goujon
- Urology, Centre Hospitalo-Universitaire Rennes, Rennes, France
| | - A. Beretta
- Urology, Centre Hospitalo-Universitaire Lyon, Lyon, France
| | - J. Papet
- Urology, Centre Hospitalo-Universitaire Rouen, Rouen, France
| | - H. Dupuis
- Urology, Centre Hospitalo-Universitaire Rouen, Rouen, France
| | - A. Panis
- Urology, Centre Hospitalo-Universitaire Créteil, Paris, France
| | - A. Peyrottes
- Urology, Hôpital Européen Georges Pompidou, Paris, France
| | - A. Lemaire
- Urology, Hôpital Saint Louis, Paris, France
| | - C. Larose
- Urology, Centre Hospitalo-Universitaire Nancy, Nancy, France
| | - L. Bettler
- Urology, Centre Hospitalo-Universitaire Dijon, Dijon, France
| | - M. Pues
- Urology, Centre Hospitalo-Universitaire Lille, Lille, France
| | - C. Joncour
- Urology, Centre Hospitalo-Universitaire Reims, Reims, France
| | - G. Stempfer
- Urology, Centre Hospitalo-Universitaire Pointe A Pitre, Guadeloupe, Pointe à Pitre, France
| | - T. Ghestem
- Urology, Centre Hospitalo-Universitaire Amiens Picardie, Amiens, France
| | - P. De Sousa
- Urology, Centre Hospitalo-Universitaire Amiens Picardie, Amiens, France
| |
Collapse
|
3
|
Ruch B, Tsering D, Bhati C, Kumar D, Saeed M, Lee SD, Khan A, Imai D, Bruno D, Levy M, Cotterell A, Sharma A. Right versus left fully robotic live donor nephrectomy and open kidney transplantation: Does the laterality of the donor kidney really matter? Asian J Urol 2023; 10:453-460. [PMID: 38024427 PMCID: PMC10659977 DOI: 10.1016/j.ajur.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 07/21/2023] [Accepted: 08/16/2023] [Indexed: 12/01/2023] Open
Abstract
Objective Robotic-assisted live donor nephrectomy (LDN) is being gradually adopted across transplant centers. The left donor kidney is preferred over right due to anatomical factors and ease of procurement. We aimed to study donor and recipient outcomes after robotic procurement and subsequent open implantation of right and left kidneys. Methods All fully robotic LDNs and their corresponding open kidney transplants performed at our center between February 2016 and December 2021 were retrospectively analyzed. Results Out of 196 robotic LDN (49 [right] vs. 147 [left]), 10 (5.1%) donors had intra-operative events (6.1% [right] vs. 4.8% [left], p=0.71). None of the LDN required conversion to open surgery. The operative times were comparable for the two groups. Nausea (13.3%) was the most common post-operative complication. There was no mortality in either LDN group. Herein, we report our outcomes on 156 recipients (39 right and 117 left allografts) excluding robotic implants, exports, and pediatric recipients. There were no significant differences between right and left kidney recipients with respect to 1-year post-transplant patient survival (100.0% vs. 98.1%, p=0.45) or graft survival (93.9% vs. 97.1%, p=0.11), or delayed graft function (7.7% vs. 5.1%, p=0.55). Conclusion Non-hand-assisted robotic live donor nephrectomies can be safely performed with excellent outcomes. Right LDN was not associated with higher incidence of complications compared to left LDN. Open implantation of robotically procured right renal allografts was not associated with higher risk of recipient complications.
Collapse
Affiliation(s)
- Brianna Ruch
- Hume-Lee Transplant Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Deki Tsering
- Hume-Lee Transplant Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Chandra Bhati
- Division of Transplant Surgery, University of Maryland, Baltimore, MD, USA
| | - Dhiren Kumar
- Hume-Lee Transplant Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Muhammad Saeed
- Hume-Lee Transplant Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Seung Duk Lee
- Hume-Lee Transplant Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Aamir Khan
- Hume-Lee Transplant Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Daisuke Imai
- Hume-Lee Transplant Center, Virginia Commonwealth University, Richmond, VA, USA
| | - David Bruno
- Hume-Lee Transplant Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Marlon Levy
- Hume-Lee Transplant Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Adrian Cotterell
- Hume-Lee Transplant Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Amit Sharma
- Hume-Lee Transplant Center, Virginia Commonwealth University, Richmond, VA, USA
| |
Collapse
|
4
|
Zhang JZ, Li S, Zhu WH, Leng XS, Zhang DF. Effect of overtime pancreaticoduodenectomy on the short-term prognosis of patients. World J Gastrointest Surg 2022; 14:419-428. [PMID: 35734628 PMCID: PMC9160684 DOI: 10.4240/wjgs.v14.i5.419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 03/23/2022] [Accepted: 04/21/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Due to the large number of operations, surgeons sometimes need to work overtime or even stay up late to perform pancreaticoduodenectomy. Fatigue and sleep deprivation can result in an increased error rate at work. There have been numerous studies about the effect of overtime surgery on the prognosis of patients. However, the effect of overtime work for pancreaticoduodenectomy on the prognosis of patients is unclear. This study explores the impact of overtime work for pancreaticoduodenectomy on the prognosis of patients.
AIM To explore the impact of overtime work for pancreaticoduodenectomy on the short-term prognosis of patients.
METHODS This was a single-center, retrospective cohort study. The patients who underwent pancreaticoduodenectomy between January 2017 and December 2019 were included. Patients were stratified by operative start time into the control group (surgery that started between 8:00 and 16:49) and the overtime group (surgery that started between 17:00 and 22:00) and compared intraoperative and postoperative parameters. The following parameters were compared between the overtime group and the control group: Operative time, blood loss, number of lymph nodes removed, duration of treatment in the Intensive Care Unit (ICU), and incidence of complications.
RESULTS From January 2017 to December 2019, a total of 239 patients underwent pancreaticoduodenectomy in the Department of Hepatobiliary Surgery of our institution. Four patients were excluded from this study due to lack of clinical data. A total of 235 patients were included, with 177 in the control group and 58 in the overtime group. There was no difference between the two groups in operative time, blood loss, number of lymph nodes removed, ICU length of stay, hospital length of stay, mortality during hospitalization. Compared with the control group, the overtime group had a higher incidence of pancreatic fistula (32.8% vs 15.8%, P < 0.05). Multivariate analysis showed that overtime work, higher Body Mass Index were independent risk factors for pancreatic fistula (P < 0.05).
CONCLUSION Overtime work for pancreaticoduodenectomy increases the incidence of pancreatic fistula. The effect of overtime surgery on the long-term prognosis of patients’ needs to be further studied.
Collapse
Affiliation(s)
- Jin-Zhu Zhang
- Department of Hepatobiliary Surgery, Peking University People's Hospital, Beijing 100044, China
| | - Shu Li
- Department of Hepatobiliary Surgery, Peking University People's Hospital, Beijing 100044, China
| | - Wei-Hua Zhu
- Department of Hepatobiliary Surgery, Peking University People's Hospital, Beijing 100044, China
| | - Xi-Sheng Leng
- Department of Hepatobiliary Surgery, Peking University People's Hospital, Beijing 100044, China
| | - Da-Fang Zhang
- Department of Hepatobiliary Surgery, Peking University People's Hospital, Beijing 100044, China
| |
Collapse
|
5
|
Treacy PJ, Barthe F, Bentellis I, Falagario UG, Prudhomme T, Imbert de La Phalecque L, Shaikh A, Albano L, Chevallier D, Durand M. Is night-time surgical procedure for renal graft at higher risk than during the day? A single center study cohort of 179 patients. Immun Inflamm Dis 2021; 10:225-234. [PMID: 34796677 PMCID: PMC8767511 DOI: 10.1002/iid3.566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 10/11/2021] [Accepted: 10/19/2021] [Indexed: 11/30/2022]
Abstract
Introduction Various surgical centers tend to postpone a kidney transplantation (KT) to the following morning than to operate at night‐time. The objective of our study was to assess whether there was any difference between daytime and night‐time renal transplantation in our institution. Method This study is a retrospective monocentric study including all the KTs that were performed between 2012 and 2013 by transplant expert surgeons in our institution. Clavien‐Dindo (CD) complications were classified according to 7 variables going from 1 to 5. Time before postgraft diuresis and delayed graft function (DGF) were also analyzed. Two groups of patients were formed according to threshold value of incision time (6.30 p.m.). Data comparison were performed using the Kruskal–Wallis nonparametric test. Results A total of 179 patients were included. Median follow‐up was 24 months. Cold ischemia time was longer in the night‐time transplantation (1082 vs. 807 min, p < .001), but rewarming time was shorter (47.24 vs. 52.15 min, p = .628). No statistically significant differences were observed between the two groups using the Kruskal–Wallis method for CD complications (Qobs: 0.076; p = .735). CD complications proportion was similar, with a majority of grade II complications (72.7% daytime group vs. 75.4% night‐time group (p = .735). DGF (19 patients for daytime group vs. 13 patients for night‐time group, p = .359) and time before postgraft diuresis (4.65 days daytime group vs. 5.27 days night‐time group, p = .422) were similar between both groups. Multivariate analysis did not show significant predictors of CD complications Grade 3 and more. Conclusion Night‐time renal transplantation did not induce more postoperative CD complications than diurnal procedures in our cohort, challenging the false preconceptions that allow surgical teams to delay this surgery.
Collapse
Affiliation(s)
- Patrick Julien Treacy
- Urology, Andrology, Renal Transplant Unit, Hôpital Pasteur 2, CHU de Nice, Nice, France
| | - Flora Barthe
- Urology, Andrology, Renal Transplant Unit, Hôpital Pasteur 2, CHU de Nice, Nice, France
| | - Imad Bentellis
- Urology, Andrology, Renal Transplant Unit, Hôpital Pasteur 2, CHU de Nice, Nice, France
| | | | - Thomas Prudhomme
- Department of Urology and Renal Transplantation, CHU Rangueil, Toulouse University Hospital, Toulouse, France
| | | | - Aysha Shaikh
- Urology, Andrology, Renal Transplant Unit, Hôpital Pasteur 2, CHU de Nice, Nice, France
| | - Laetitia Albano
- Department of Renal Transplantation, Hôpital Pasteur 2, Nice Sophia-Antipolis University, Nice, France
| | - Daniel Chevallier
- Urology, Andrology, Renal Transplant Unit, Hôpital Pasteur 2, CHU de Nice, Nice, France
| | - Matthieu Durand
- Urology, Andrology, Renal Transplant Unit, Hôpital Pasteur 2, CHU de Nice, Nice, France.,Department of Renal Transplantation, Hôpital Pasteur 2, Nice Sophia-Antipolis University, Nice, France
| |
Collapse
|
6
|
Ville S, Lorent M, Kerleau C, Asberg A, Legendre C, Morelon E, Buron F, Garrigue V, Le Quintrec M, Girerd S, Ladrière M, Albano L, Sicard A, Glotz D, Lefaucheur C, Branchereau J, Jacobi D, Giral M. Timing of Kidney Clamping and Deceased Donor Kidney Transplant Outcomes. Clin J Am Soc Nephrol 2021; 16:1704-1714. [PMID: 34625421 PMCID: PMC8729417 DOI: 10.2215/cjn.03290321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 09/22/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES The fact that metabolism and immune function are regulated by an endogenous molecular clock that generates circadian rhythms suggests that the magnitude of ischemia reperfusion, and subsequent inflammation on kidney transplantation, could be affected by the time of the day. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We evaluated 5026 individuals who received their first kidney transplant from deceased heart-beating donors. In a cause-specific multivariable analysis, we compared delayed graft function and graft survival according to the time of kidney clamping and declamping. Participants were divided into those clamped between midnight and noon (ante meridiem [am] clamping group; 65%) or clamped between noon and midnight (post meridiem [pm] clamping group; 35%), and, similarly, those who underwent am declamping (25%) or pm declamping (75%). RESULTS Delayed graft function occurred among 550 participants (27%) with am clamping and 339 (34%) with pm clamping (adjusted odds ratio, 0.81; 95% confidence interval, 0.67 to 0.98; P=0.03). No significant association was observed between clamping time and overall death-censored graft survival (hazard ratio, 0.92; 95% confidence interval, 0.77 to 1.10; P=0.37). No significant association of declamping time with delayed graft function or graft survival was observed. CONCLUSIONS Clamping between midnight and noon was associated with a lower incidence of delayed graft function, whereas declamping time was not associated with kidney graft outcomes.
Collapse
Affiliation(s)
- Simon Ville
- Institut de Transplantation Urologie Néphrologie, CHU Nantes, Nantes, France
| | - Marine Lorent
- CRTI UMR 1064, Institut National de la Santé et de la Recherche Médicale (INSERM), University of Nantes, ITUN, CHU Nantes, RTRS Centaure, Nantes, France
| | - Clarisse Kerleau
- CRTI UMR 1064, Institut National de la Santé et de la Recherche Médicale (INSERM), University of Nantes, ITUN, CHU Nantes, RTRS Centaure, Nantes, France
| | - Anders Asberg
- Department of Transplantation Medicine, Oslo University Hospital, Department of Pharmacy, University of Oslo, Oslo, Norway
| | - Christophe Legendre
- Kidney Transplant Center, Necker University Hospital, Assistance Publique-Hôpitaux de Paris, RTRS Centaure, Paris Descartes and Sorbonne Paris Cité Universities, Paris, France
| | - Emmanuel Morelon
- Nephrology, Transplantation and Clinical Immunology Department, RTRS Centaure, Edouard Herriot University Hospital, Hospices Civils, Lyon, France
| | - Fanny Buron
- Nephrology, Transplantation and Clinical Immunology Department, RTRS Centaure, Edouard Herriot University Hospital, Hospices Civils, Lyon, France
| | - Valérie Garrigue
- Nephrology, Dialysis and Transplantation Department, Lapeyronie University Hospital, Montpellier, France
| | - Moglie Le Quintrec
- Nephrology, Dialysis and Transplantation Department, Lapeyronie University Hospital, Montpellier, France
| | - Sophie Girerd
- Renal Transplantation Department, Brabois University Hospital, Nancy, France
| | - Marc Ladrière
- Renal Transplantation Department, Brabois University Hospital, Nancy, France
| | - Laetitia Albano
- Department of Nephrology and Renal Transplantation, Hospital Pasteur, Nice, France
| | - Antoine Sicard
- Department of Nephrology and Renal Transplantation, Hospital Pasteur, Nice, France
| | - Denis Glotz
- Department of Nephrology and Renal Transplantation, CHU Paris-GH Saint-Louis, Lariboisière, France
| | - Carmen Lefaucheur
- Department of Nephrology and Renal Transplantation, CHU Paris-GH Saint-Louis, Lariboisière, France
| | - Julien Branchereau
- Institut de Transplantation Urologie Néphrologie, CHU Nantes, Nantes, France,Urology Unit, University of Nantes, ITUN, CHU Nantes, Nantes, France
| | - David Jacobi
- Thorax Institut, INSERM, Centre National de la Recherche Scientifique (CNRS), University of Nantes, CHU Nantes, Nantes, France
| | - Magali Giral
- Institut de Transplantation Urologie Néphrologie, CHU Nantes, Nantes, France,INSERM, UMR 1246 SPHERE, Nantes University, Tours University, Nantes, France,Center for Clinical Investigation in Biotherapy, Nantes, France
| | | |
Collapse
|
7
|
Guerrero ER, García-Baquero R, Pérez CS, Fernández-Ávila CM, Mazuecos AB, Álvarez-Ossorio JL. Nighttime Kidney Transplant From Donor With Controlled Cardiac Death: Greater Functionality at the Cost of More Complications? Transplant Proc 2021; 53:2666-2671. [PMID: 34656367 DOI: 10.1016/j.transproceed.2021.07.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 07/16/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Kidney transplantation surgery from controlled cardiac death donor (Maastricht III) is frequently performed at night, without taking into account the accumulated fatigue that the surgical team may experience. The objective of the study is to assess whether surgical complications and the functionality of the graft in the short and long term are affected by the time of day in which kidney transplantation from controlled cardiac death donors is performed. METHODS A retrospective observational study was carried out. Patient were classified according to the start of surgery, daytime hours (8:00 AM to 7:59 PM), and nighttime hours (8:00 PM to 7:59 AM). Baseline and intraoperative parameters, postoperative complications, and parameters related to graft functionality were analyzed. RESULTS A total of 77 patients were included: 37 patients had kidney transplantations performed during the daytime (48.05%), and 40 patients had kidney transplantations performed at nighttime (51.95%). No statistically significant differences were found between the baseline characteristics of both groups except for sex (55.0% men in daytime vs 78.4% men in nighttime, P = .03) and time on pretransplant dialysis (33.1 months in daytime vs 13.8 months in nighttime, P = .008). The incidence of surgical complications and the functionality of the graft was similar in both groups; however, the surgical time was shorter in night transplants (163.2 minutes in daytime vs 136.5 minutes at nighttime, P = .0006) CONCLUSION: The performance of kidney transplants at night is not associated, either in the short or long term, with an increase in surgical complications or conditions leading to the deterioration in the functionality of the graft.
Collapse
Affiliation(s)
- Estefania Ruiz Guerrero
- Kidney Transplant Unit, Urology Department, Hospital Universitario Puerta del Mar, Cádiz, Spain.
| | - Rodrigo García-Baquero
- Kidney Transplant Unit, Urology Department, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | | | | | | | | |
Collapse
|
8
|
Montaigne D, Alhawajri N, Jacquelinet M, Coppin A, Frimat M, Bouyé S, Lebuffe G, Staels B, Jacquelinet C, Hazzan M. Day-Time Declamping Is Associated with Better Outcomes in Kidney Transplantation: The Circarein Study. J Clin Med 2021; 10:2322. [PMID: 34073444 DOI: 10.3390/jcm10112322] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 05/15/2021] [Accepted: 05/22/2021] [Indexed: 11/17/2022] Open
Abstract
Despite improvements in organ preservation techniques and efforts to minimize the duration of cold ischemia, ischemia–reperfusion (IR) injury remains associated with poor graft function and long-term survival in kidney transplantation. We recently demonstrated a clinically significant day-time variation in myocardial tolerance to IR, transcriptionally orchestrated by the circadian clock. Patient and graft post-transplant survival were studied in a cohort of 10,291 patients first transplanted between 2006 and 2017 to test whether kidney graft tolerance to IR depends on the time-of-the-day of clamping/declamping, and thus impacts graft and patient survival. Post-transplant 1- and 3-year survival decreased with increasing ischemia duration. Time-of-the-day of clamping did not influence outcomes. However, night-time (vs. day-time) declamping was associated with a significantly worse post-transplant survival. After adjustment for other predictors, night-time (vs. day-time) declamping remained associated with a worse 1-year (HR = 1.26 (1.08–1.47), p = 0.0028 by Cox multivariable analysis) and 3-year (HR = 1.14 (1.02–1.27), p = 0.021) outcome. Interestingly, the deleterious impact of prolonged ischemia time (>15 h) was partially compensated by day-time (vs. night-time) declamping. Compared to night-time declamping, day-time declamping was associated with a better prognosis of kidney transplantation despite a longer duration of cold ischemia.
Collapse
|
9
|
Koda N, Oshima Y, Koda K, Shimada H. Surgeon fatigue does not affect surgical outcomes: a systematic review and meta-analysis. Surg Today 2021; 51:659-68. [PMID: 32924066 DOI: 10.1007/s00595-020-02138-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 07/26/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To systematically review the effects of surgeon fatigue on postoperative mortality and postoperative complications after elective and non-elective surgeries. METHODS A database search was conducted for original articles published in PubMed between 2000 and 2020 with the keywords: "surgeon," "sleep deprivation," "sleep deprived," "fatigued," "mortality," "morbidity," and "outcomes." We selected articles that disclosed actual numbers of patients who underwent surgery by fatigued or rested surgeons, rates of postoperative mortality, or total postoperative complications. RESULTS Of the 1427 articles identified, 16 met the selection criteria and were included. Eight of the 16 also included total postoperative complications. Analysis revealed no significant differences in the rates of postoperative mortality after elective and non-elective surgeries or total postoperative complications of elective surgeries or non-elective surgeries performed by fatigued vs. rested surgeons. The relative risks were 1.03 [95% confidence interval (CI), 0.86-1.24], 1.08 (95% CI, 0.85-1.38), 0.99 (95% CI, 0.95-1.04), and 0.93 (95% CI, 0.67-1.28), respectively. CONCLUSION Surgeon fatigue does not affect the rates of postoperative mortality or total postoperative complications after elective surgeries and may have little to no effect on the rates of postoperative mortality or total postoperative complications after non-elective surgeries.
Collapse
|
10
|
Ville S, Branchereau J, Cornuaud A, Dantal J, Legendre C, Buron F, Morelon E, Garrigue V, Lequentrec M, Albano L, Cassuto E, Girerd S, Ladrière M, Glotz D, Lefaucher C, Kerleau C, Foucher Y, Giral M. The weekend effect in kidney transplantation outcomes: a French cohort-based study. Transpl Int 2020; 33:1030-1039. [PMID: 32428980 DOI: 10.1111/tri.13653] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 01/13/2020] [Accepted: 05/11/2020] [Indexed: 11/26/2022]
Abstract
Numerous studies have reported a weekend effect on outcomes for diseases treated at hospitals. No study has been conducted in France for kidney transplantation. We therefore performed a cohort-based study to evaluate whether outcomes of kidney transplant recipients display a weekend effect. Data were extracted from the French DIVAT cohort. Patients aged 18 years and older, transplanted with a single kidney from deceased donors between 2005 and 2017 were studied. Linear regression, logistic regression, and cause-specific Cox model were used. Among the 6652 studied patients, 4653 patients were transplanted during weekdays (69.9%) versus 1999 during weekends (30.1%). The only statistically significant difference was the percentage of patients with vascular surgical complication(s) at 30 days: 13.3% in the weekend group versus 16.2% in the weekday group 0.79 (95% CI: 0.68; 0.92). We did not observe other significant differences for the other outcomes: patient or graft survival, the risk of acute rejection episodes, the 30-day percentage of urological complications, and the 1-year estimated glomerular filtration rate. Our study highlights a small protective weekend effect with less post-surgery vascular complications compared to weekdays. This paradox might be explained by a different handling of weekend transplantations.
Collapse
Affiliation(s)
- Simon Ville
- CRTI UMR 1064, Université de Nantes, ITUN, RTRS Centaure, Inserm, Nantes, France.,INSERM UMR 1246 - SPHERE, Nantes University, Tours University, Nantes, France
| | - Julien Branchereau
- CRTI UMR 1064, Université de Nantes, ITUN, RTRS Centaure, Inserm, Nantes, France.,INSERM UMR 1246 - SPHERE, Nantes University, Tours University, Nantes, France
| | | | - Jacques Dantal
- CRTI UMR 1064, Université de Nantes, ITUN, RTRS Centaure, Inserm, Nantes, France.,INSERM UMR 1246 - SPHERE, Nantes University, Tours University, Nantes, France
| | - Christophe Legendre
- Kidney Transplant Center, Necker University Hospital, APHP, RTRS Centaure, Paris Descartes and Sorbonne Paris Cité Universities, Paris, France
| | - Fanny Buron
- Nephrology, Transplantation and Clinical Immunology Department, RTRS Centaure, Edouard Herriot University Hospital, Hospices Civils, Lyon, France
| | - Emmanuel Morelon
- Nephrology, Transplantation and Clinical Immunology Department, RTRS Centaure, Edouard Herriot University Hospital, Hospices Civils, Lyon, France
| | - Valérie Garrigue
- Nephrology, Dialysis and Transplantation Department, Lapeyronie University Hospital, Montpellier, France
| | - Moglie Lequentrec
- Nephrology, Dialysis and Transplantation Department, Lapeyronie University Hospital, Montpellier, France
| | - Laetitia Albano
- Department of Nephrology and Renal Transplantation, Hospital Pasteur, Nice, France
| | - Elisabeth Cassuto
- Department of Nephrology and Renal Transplantation, Hospital Pasteur, Nice, France
| | - Sophie Girerd
- Renal Transplantation Department, Brabois University Hospital, Nancy, France
| | - Marc Ladrière
- Renal Transplantation Department, Brabois University Hospital, Nancy, France
| | - Denis Glotz
- Department of Nephrology and Renal Transplantation, CHU Paris-GH St-Louis Lariboisière, Paris, France
| | - Carmen Lefaucher
- Department of Nephrology and Renal Transplantation, CHU Paris-GH St-Louis Lariboisière, Paris, France
| | - Clarisse Kerleau
- CRTI UMR 1064, Université de Nantes, ITUN, RTRS Centaure, Inserm, Nantes, France.,INSERM UMR 1246 - SPHERE, Nantes University, Tours University, Nantes, France
| | - Yohann Foucher
- INSERM UMR 1246 - SPHERE, Nantes University, Tours University, Nantes, France.,Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Magali Giral
- CRTI UMR 1064, Université de Nantes, ITUN, RTRS Centaure, Inserm, Nantes, France.,Kidney Transplant Center, Necker University Hospital, APHP, RTRS Centaure, Paris Descartes and Sorbonne Paris Cité Universities, Paris, France.,Centre d'Investigation Clinique en Biothérapie, Nantes, France
| | | |
Collapse
|
11
|
Becker F, Voß T, Mohr A, Mehdorn AS, Schütte-Nütgen K, Reuter S, Kabar I, Bormann E, Vowinkel T, Palmes D, Brockmann JG, Pascher A, Bahde R, Kebschull L, Vogel T. Impact of nighttime procedures on outcomes after liver transplantation. PLoS One 2019; 14:e0220124. [PMID: 31329648 DOI: 10.1371/journal.pone.0220124] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 07/09/2019] [Indexed: 01/12/2023] Open
Abstract
Background Sleep deprivation is a well-known risk factor for the performance of medical professionals. Solid organ transplantation (especially orthotopic liver transplantation (oLT)) appears to be vulnerable since it combines technically challenging operative procedures with an often unpredictable start time, frequently during the night. Aim of this study was to analyze whether night time oLT has an impact on one-year graft and patient survival. Material and methods Deceased donor oLTs between 2006 and 2017 were retrospectively analyzed and stratified for recipients with a start time at day (8 a.m. and 6 p.m.) or at night (6 p.m. to 8 a.m.). We examined donor as well as recipient demographics and primary outcome measure was one-year patient and graft survival. Results 350 oLTs were conducted in the study period, 154 (44%) during daytime and 196 (56%) during nighttime. Donor and recipient variables were comparable. One-year patient survival (daytime 75.3% vs nighttime 76.5%, p = 0.85) as well as graft survival (daytime 69.5% vs nighttime 73.5%, p = 0.46) were similar between the two groups. Frequencies of reoperation (daytime 53.2% vs nighttime 55.1%, p = 0.74) were also not significantly different. Conclusion Our retrospective single center data derived from a German transplant center within the Eurotransplant region provides evidence that oLT is a safe procedure irrespective of the starting time. Our data demonstrate that compared to daytime surgery nighttime liver transplantation is not associated with a greater risk of surgical complications. In addition, one-year graft and patient survival do not display inferior results in patients undergoing nighttime transplantation.
Collapse
|
12
|
Sugünes N, Bichmann A, Biernath N, Peters R, Budde K, Liefeldt L, Schlomm T, Friedersdorff F. Analysis of the Effects of Day-Time vs. Night-Time Surgery on Renal Transplant Patient Outcomes. J Clin Med 2019; 8:E1051. [PMID: 31323849 DOI: 10.3390/jcm8071051] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 07/11/2019] [Accepted: 07/12/2019] [Indexed: 02/01/2023] Open
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.
Collapse
|
13
|
Guo QH, Liu QL, Hu XJ, Li Y, Zheng J, Xue WJ. Comparison of nighttime and daytime operation on outcomes of kidney transplant with deceased donors: a retrospective analysis. Chin Med J (Engl) 2019; 132:395-404. [PMID: 30707168 DOI: 10.1097/CM9.0000000000000056] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background: Kidney transplant is always emergent operations and frequently need to be performed at nighttime to reduce cold ischemia time (CIT). Previous studies have revealed that fatigue and sleep deprivation can result in adverse consequences of medical procedures. This study aimed to evaluate whether nighttime operation has adverse impact on kidney transplant. Methods: A retrospective analysis of recipients accepted kidney transplant from deceased donors in one center from 2014 to 2016 was performed. Daytime transplant was defined as operation started after 8 am or ended before 8 pm and nighttime operation was defined as operation ended after 8 pm or started before 8 am. The incidences of complications such as delayed graft function, acute rejection, surgical complications and nosocomial infections were compared between 2 groups. Student's t-test was used to analyze continuous variables such as serum creatinine (Scr) at 1-year of post-transplant. The Chi-square test was used to analyze categorical variables. Differences in recipients and graft survival were analyzed using Kaplan–Meier methodology and log-rank tests. Results: Among the 443 recipients, 233 (52.6%) were classified into the daytime group and the others 210 (47.4%) were in the nighttime group. The 1-year survival rate of recipients was similar for the recipients in the daytime and nighttime groups (95.3% vs. 95.2%, P = 0.981). Although the 1-year graft survival rate in the nighttime group was slightly superior to that in the daytime group, the difference was not significant (92.4% vs. 88.4%, P = 0.164). Furthermore, Scr and incidence of complications were also not significantly different between the 2 groups. Conclusions: Our results suggested that operation time of kidney transplant with short CIT has no significant impact on the outcome of kidney transplant. Nighttime operation of kidney transplant with short CIT could be postponed to the following day to alleviate the burden on medical staffs and avoid the potential risk.
Collapse
|
14
|
Pache B, Grass F, Fournier N, Hübner M, Demartines N, Hahnloser D. Surgical teaching does not increase the risk of intraoperative adverse events. Int J Colorectal Dis 2018; 33:1715-22. [PMID: 30143855 DOI: 10.1007/s00384-018-3143-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/10/2018] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Training and teaching are cornerstones in developing surgical skills. The present study aimed to compare intraoperative outcomes of colonic resections among fellows, consultants, and supervised trainees. METHODS Data of consecutive colonic resections including demographics, surgical details, and intraoperative outcomes were recorded in a prospectively maintained institutional database. All procedures were standardized and divided in three groups according to the main surgeons experience (fellow or consultant) and whether the procedure was taught. After weighting by inverse treatment probability, intraoperative adverse events including reactive conversion, blood loss, and operating time were compared between these three groups. RESULTS Six hundred sixty-four colectomies were analyzed between January 2014 and October 2017. Among them, 289 (43.5%) were taught. After weighted propensity score analysis, there was no difference between the three groups (fellow taken as reference), for intraoperative adverse event rate (odd ratio (OR) consultant 1.448 (IQR 0.728-2.878), p = 0.282; OR teaching 0.689 (IQR 0.295-1.609), p = 0.381), operating time (beta coefficient 0.76 (- 21.91-23.42), p = 0.947; beta coefficient - 10.79 (- 28.34-6.75), p = 0.919), conversion rates (OR 0.748 (0.329-1.515), p = 0.412; OR 1.025 (0.537-1.954), p = 0.940), pre-emptive conversion (OR 1.994 (0.198-20.032), p = 0.552; OR 0.659 (0.145-2.991), p = 0.583), intraoperative blood loss (beta coefficient 21.19 (- 25.87-68.25), p = 0.368; beta coefficient - 12.34 (- 56.13-31.44), p = 0.573), intraoperative transfusion (OR 1.962 (0.813-4.735), p = 0.127; OR 0.670 (0.260-1.727), p = 0.397), and rates of unusual bleeding (OR 1.273 (0.698-2.321), p = 0.422; OR 0.572 (0.290-1.126), p = 0.099). Time to preemptive conversion was shorter when procedures were performed by consultants (beta coefficient - 25.51 (- 47.71 to - 3.31), p = 0.025), while no difference was found for the teaching group (beta coefficient 4.48 (- 30.95-40.62), p = 0.788). CONCLUSION Within a standardized teaching environment, colonic resections were safely performed regardless of the surgical setting in the present cohort. Teaching does not increase intraoperative adverse events.
Collapse
|
15
|
de Boer J, Van der Bogt K, Putter H, Ooms-de Vries K, Haase-Kromwijk B, Pol R, De Jonge J, Dejong K, Nijboer M, Van der Vliet D, Braat D. Surgical quality in organ procurement during day and night: an analysis of quality forms. BMJ Open 2018; 8:e022182. [PMID: 30478108 PMCID: PMC6254412 DOI: 10.1136/bmjopen-2018-022182] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVES To analyse a potential association between surgical quality and time of day. DESIGN A retrospective analysis of complete sets of quality forms filled out by the procuring and accepting surgeon on organs from deceased donors. SETTING Procurement procedures in the Netherlands are organised per region. All procedures are performed by an independent, dedicated procurement team that is associated with an academic medical centre in the region. PARTICIPANTS In 18 months' time, 771 organs were accepted and procured in The Netherlands. Of these, 17 organs were declined before transport and therefore excluded. For the remaining 754 organs, 591 (78%) sets of forms were completed (procurement and transplantation). Baseline characteristics were comparable in both daytime and evening/night-time with the exception of height (p=0.003). PRIMARY OUTCOME MEASURE All complete sets of quality forms were retrospectively analysed for the primary outcome, procurement-related surgical injury. Organs were categorised based on the starting time of the procurement in either daytime (8:00-17:00) or evening/night-time (17:00-8:00). RESULTS Out of 591 procured organs, 129 organs (22%) were procured during daytime and 462 organs (78%) during evening/night-time. The incidence of surgical injury was significantly lower during daytime; 22 organs (17%) compared with 126 organs (27%) procured during evening/night-time (p=0.016). This association persists when adjusted for confounders. CONCLUSIONS This study shows an increased incidence of procurement-related surgical injury in evening/night-time procedures as compared with daytime. Time of day might (in)directly influence surgical performance and should be considered a potential risk factor for injury in organ procurement procedures.
Collapse
Affiliation(s)
- Jacob de Boer
- Department of Surgery, Leids Universitair Medisch Centrum, Leiden, Netherlands
- Nederlandse Transplantatie Stichting, Leiden, The Netherlands
| | - Koen Van der Bogt
- Department of Surgery, Leids Universitair Medisch Centrum, Leiden, Netherlands
- Department of Surgery, Medisch Centrum Haaglanden, Den Haag, Zuid-Holland, Netherlands
| | - Hein Putter
- Leids Universitair Medisch Centrum, Statistical Department, Leiden, Netherlands
| | | | | | - Robert Pol
- Department of Surgery, Universitair Medisch Centrum Groningen, Groningen, Netherlands
| | - Jeroen De Jonge
- Department of Surgery, Erasmus MC, Rotterdam, The Netherlands
| | - Kees Dejong
- Department of Surgery, Maastricht Universitair Medisch Centrum+, Maastricht, The Netherlands
| | - Mijntje Nijboer
- Department of Surgery, Leids Universitair Medisch Centrum, Leiden, Netherlands
| | | | - Dries Braat
- Department of Surgery, Leids Universitair Medisch Centrum, Leiden, Netherlands
| |
Collapse
|
16
|
Hendrikx J, Van Raemdonck D, Pirenne J, Fieuws S, Rex S. Outcome of transplantation performed outside the regular working hours: A systematic review and meta-analysis of the literature. Transplant Rev (Orlando) 2018; 32:168-77. [PMID: 29907370 DOI: 10.1016/j.trre.2018.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 04/27/2018] [Accepted: 05/01/2018] [Indexed: 12/31/2022]
Abstract
Transplant procedures are frequently performed outside the regular working hours (after hours). In general surgery, several studies observed worse outcomes for operations performed after hours. The predetermined hypothesis was that patients undergoing transplantation during after hours might suffer from an excess in post-operative mortality and morbidity when compared to patients undergoing transplantations during the regular working hours. A systematic review of the PubMed database identified 11,993 records, of which eleven cohort studies including a total of 287,741 patients investigated the association between the starting time of transplant surgery and postoperative mortality (primary outcome) and/or morbidity (secondary outcome). Eight studies evaluated kidney transplants (in 165,277 patients), two studies analyzed liver transplants (in 95,346 patients), and one study investigated transplantations of thoracic organs (in 27,118 patients). Results were conflicting with two studies (in liver and lung transplantation) showing an increased mortality for transplantations performed after hours, and five studies showing no effects on mortality. A meta-analysis on estimates from four studies yielded a hazard ratio of 1.01 (95% CI, 0.98 to 1.04) for mortality comparing transplantations performed during versus outside the regular working hours. The evidence was also inconclusive for a variety of morbidity outcomes with studies demonstrating either a deterioration of outcome, no effect or an improved outcome for after hours procedures. On the basis of the available evidence, it appears impossible to give an unequivocal recommendation regarding starting times in transplant surgery.
Collapse
|
17
|
Schütte-Nütgen K, Thölking G, Dahmen M, Becker F, Kebschull L, Schmidt R, Pavenstädt H, Suwelack B, Reuter S. Is there a "weekend effect" in kidney transplantation? PLoS One 2017; 12:e0190227. [PMID: 29284052 DOI: 10.1371/journal.pone.0190227] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 12/11/2017] [Indexed: 11/21/2022] Open
Abstract
The ‘weekend effect’ describes increased adverse outcomes after weekend hospitalization. We examined weekend-weekday differences in the outcome of 580 patients following renal transplantation (RTx, brain dead donors) between January 2007 and December 2014 at our center. 3-year patient and graft survival, incidence of delayed graft function (DGF), acute rejections and estimated glomerular filtration rate (eGFR, CKD-EPI) at 1 year as well as surgical complications were assessed. Of all 580 transplants, 416 (71.7%) were performed on weekdays (Monday-Friday) and 164 (28.3%) on weekends (Saturday-Sunday). 3-year patient and graft survival, frequencies of DGF, acute rejections and 1-year eGFR as well as length of hospital stay were similar between RTx patients transplanted on weekdays or weekends, respectively. However, a noticeable difference was detected with regard to surgical complications which were more frequent in RTx patients transplanted on weekends. All results remained consistent across all definitions of weekend status. Our results suggest that weekend transplant status does not affect functional short-term and long-term outcomes after RTx. The standardized protocols and operationalized processes applied in RTx might contribute to this finding and may provide a model for other medical procedures that are performed on weekends to improve efficiency and outcomes. The higher rate of surgical complications after weekend RTx needs further elaboration to fully assess the presence of a weekend effect in RTx.
Collapse
|
18
|
Manfredini R, Gallerani M, De Giorgi A, Tiseo R, Lamberti N, Manfredini F, Forcellini S, Storari A, La Manna G, Fabbian F. Renal Transplantation and Outcome. Prog Transplant 2016; 26:397-398. [DOI: 10.1177/1526924816665368] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
Emergency surgery represents an independent risk factor for death and postoperative complications. The aim of this study was to investigate the literature data regarding outcome of daytime or nighttime renal transplantation surgery. Relevant papers, focused on renal transplantation surgery, time of the day, and complications, were searched across the PubMed database. We used the following search terms: “renal”, “transplantation”, “surgery”, “daytime”, “nighttime”, and “outcome”. A total of five papers, including 6,991 adult patients were evaluated. All patients received renal transplantation from deceased donor. Daytime or nighttime surgery do not seem to negatively impact on graft survival in renal transplantation. However, two out five studies reported higher odds of complications after nighttime operation. Since it is not possible to predict the availability of a deceased donor, nighttime surgery remains a valid option when necessary, maybe deserving a higher level of caution to reduce or avoid complications.
Collapse
Affiliation(s)
- Roberto Manfredini
- Department of Medical Sciences, Clinica Medica Unit, School of Medicine, University of Ferrara, Ferrara, Italy
| | - Massimo Gallerani
- Department of Internal Medicine, University Hospital of Ferrara, Ferrara, Italy
| | - Alfredo De Giorgi
- Department of Medical Sciences, Clinica Medica Unit, School of Medicine, University of Ferrara, Ferrara, Italy
| | - Ruana Tiseo
- Department of Medical Sciences, Clinica Medica Unit, School of Medicine, University of Ferrara, Ferrara, Italy
| | - Nicola Lamberti
- Department of Biomedical Sciences and Surgical Specialties, School of Medicine, University of Ferrara, Ferrara, Italy
| | - Fabio Manfredini
- Department of Biomedical Sciences and Surgical Specialties, School of Medicine, University of Ferrara, Ferrara, Italy
| | - Silvia Forcellini
- Department of Specialistic Medicine, Nephrology Unit, University Hospital of Ferrara, Ferrara, Italy
| | - Alda Storari
- Department of Specialistic Medicine, Nephrology Unit, University Hospital of Ferrara, Ferrara, Italy
| | - Gaetano La Manna
- Department of Specialistic, Diagnostic and Experimental Medicine, School of Medicine, Nephrology and Transplantation Unit, University of Bologna, Bologna, Italy
| | - Fabio Fabbian
- Department of Medical Sciences, Clinica Medica Unit, School of Medicine, University of Ferrara, Ferrara, Italy
| |
Collapse
|