Nighttime Emergency Surgery: Higher Patient Acuity, Greater Challenges

Background Patient outcomes in emergency general surgery (EGS) may be influenced by the time of day, with prior studies suggesting worse outcomes for nighttime procedures. This study examines differences in damage control laparotomy (DCL) utilization and mortality between daytime and nighttime emergent laparotomies. Methods Retrospective cohort study from January, 2015 to December, 2023 of patients undergoing emergent exploratory laparotomy during either daytime (7:00 AM-5:00 PM) or nighttime (5:00 PM-7:00 AM) was performed. The primary outcome was all-cause inpatient mortality. Secondary outcomes included DCL rates, complications, critical care metrics, and hospital length of stay. Between-group differences were assessed, and multivariate logistic regression was used to evaluate the effect of nighttime presentation on DCL and mortality. Results Among 1279 patients, 710 received daytime surgery (56%). Nighttime patients (n = 569, 44%) had higher ASA class 5 proportions (8.6% vs 4.8%, P = .0062) and greater intraoperative vasopressor use (62% vs 52%, P = .0350). Damage control laparotomy was more frequent at night (50.4% vs 38.7%). Mortality was higher for nighttime cases (18.3% vs 14.1%), independent of treatment DCL. Nighttime surgery was associated with significantly greater rates of ICU admission, mechanical ventilation, and vasopressor use, but durations of these therapies were not significantly different between groups. Nighttime surgery showed an odds ratio of 1.42 for receiving DCL (95% CI 1.06-1.90, P = .017), but it was not clearly associated with mortality. Conclusions For EGS patients, nighttime surgery is associated with higher DCL utilization and mortality compared to daytime surgery. These findings are likely due to higher patient acuity and hemodynamic instability at night.