Emergency surgery represents an independent risk factor for death and postoperative complications, and complications appear to be not fully explained by preoperative risk factors. Aim of this study was to investigate literature data regarding outcome of renal transplantation surgery performed during day-time and night-time.
Relevant papers, focused on renal transplantation surgery and time of the day and complications, were searched across the PubMed and Embase database.
The following Medical Subject Heading (MeSH) terms were used: “renal”, “transplantation”, “surgery”, “day-time”, “night-time” and “outcome”.
A total of 5 papers, including 6991 patients (average age 50 years) were investigated (Seow YY-2004 [1]), (Fechner G, 2008 [2]), (Shaw TM, 2012 [3]), (Kienzl-Wagner, 2013 [4] (full text)), (Brunschot DM, 2016 [5]).
All analysed patients received renal transplantation from deceased donor. Nighttime operations were associated with a significant higher risk of long-term graft failure and higher percentage of surgical complications. In particular, operations started between 12:00 and 03:00 had greatest odds of any complication (OR=3.49); operations started between 03:00 and 06:00 had greatest odds of urologic complications (OR=20.00). Delayed graft function and patient and graft survival were not different in the two different time periods (Fig.1).
Outcome of kidney transplantation could be affected by several variables, andtime of surgery is one of the factors that should be considered. Off-hours could be considered time during which patients are at higher risk of complications
[1] Seow YY, Alkari B, Dyer P et al. Cold ischemia time, surgeon, time of day, and surgical complications. Transplantation 2004 May 15;77(9):1386-9
[2] Fechner G, Pezold C, Hauser S et al. Kidney's nightshift, kidney's nightmare? Comparison of daylight and nighttime kidney transplantation: impact on complications and graft survival. Transplantation proceedings 2008 Jun;40(5):1341-4
[3] Shaw TM, Lonze BE, Feyssa EL et al. Operative start times and complications after kidney transplantation. Clinical transplantation 2012 May-Jun;26(3):E177-83
[4] Kienzl-Wagner K, Schneiderbauer S, Bösmüller C et al. Nighttime procedures are not associated with adverse outcomes in kidney transplantation. Transplant international : official journal of the European Society for Organ Transplantation 2013 Sep;26(9):879-85 (full text)
[5] Brunschot DM, Hoitsma AJ, van der Jagt MF et al. Nighttime kidney transplantation is associated with less pure technical graft failure. World journal of urology 2016 Jul;34(7):955-61
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