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Title: | Outcome of transplantation performed outside the regular working hours: A systematic review and meta-analysis of the literature | Authors: | Hendrikx, Jore Van Raemdonck, Dirk Pirenne, Jacques FIEUWS, Steffen Rex, Steffen |
Issue Date: | 2018 | Publisher: | ELSEVIER SCIENCE INC | Source: | TRANSPLANTATION REVIEWS, 32(3), p. 168-177 | 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 postoperative 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. (C) 2018 Elsevier Inc. All rights reserved. | Notes: | [Hendrikx, Jore; Rex, Steffen] Univ Hosp Leuven, Dept Anesthesiol, Herestr 49, Leuven 3000, Belgium. [Van Raemdonck, Dirk] Univ Hosp Leuven, Dept Thorac Surg, Leuven, Belgium. [Van Raemdonck, Dirk] Katholieke Univ Leuven, Dept Clin & Expt Med, Leuven, Belgium. [Pirenne, Jacques] Univ Hosp Leuven, Dept Abdominal Transplant Surg, Leuven, Belgium. [Pirenne, Jacques] Katholieke Univ Leuven, Dept Microbiol & Immunol, Leuven, Belgium. [Fieuws, Steffen] Katholieke Univ Leuven, Interuniv Inst Biostat & Stat Bioinformat, Leuven, Belgium. [Fieuws, Steffen] Univ Hasselt, Hasselt, Belgium. [Rex, Steffen] Katholieke Univ Leuven, Dept Cardiovasc Sci, Leuven, Belgium. | Keywords: | Graft survival; Organ transplantation; Night-time; Patient survival; Weekend effect;Graft survival; Organ transplantation; Night-time; Patient survival; Weekend effect | Document URI: | http://hdl.handle.net/1942/28522 | ISSN: | 0955-470X | DOI: | 10.1016/j.trre.2018.05.001 | ISI #: | 000439253800007 | Rights: | 2018 Elsevier Inc. All rights reserved | Category: | A1 | Type: | Journal Contribution | Validations: | ecoom 2019 |
Appears in Collections: | Research publications |
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