Title: Time of Day Effect on Surgical Complications Following Liver Transplantation
Abstract: Purpose: Liver transplantation (LT) start time can be dictated by several factors and there is growing concern that it may contribute to complications. This study reviewed the relationship between developing surgical complications following liver transplant and time of starting surgery. Methods: We conducted retrospective analysis of our center's liver transplant records from 1995 to October 2008 and extracted start, end and total operation times. We collected data on donor and recipient characterstics: Age, Gender, indication for LT, MELD score at LT, Donor age, Donation after Cardiac Death (DCD) or Donation after Neurologic Death (DN), and Cold Ischemic Time (CIT). We categorized surgical start time in to eight 3-hour categories (starting 12:00AM - 3:00AM as first category). Type and number of surgical complications, number of transfusions and duration of surgery were also entered for analysis. Patients with multiple organ transplantation were excluded from the analysis. For patients who underwent re-transplantation, only their first LT operation was included for analysis. Results: A total of 551 LT operations were included for this study. The median recipient age was 51 years, 67% were males and 84.4% Caucasians. The median pre-LT MELD score was 23. DCD accounted for 6.4% of transplants and the mean CIT for our group was 9.2 hours. The mean duration of the LT procedure was 9.18 hours. Average transfusion requirements were 8.62 units of packed red blood cells and 10.78 units of FFP. Among 551 LT operations there was 247 surgical, medical, and/or non-transplant surgical complications. We found no significant difference in the rate of LT-related surgical complications when analyzed by operation start time. In fact, the rate of occurrence of relevant surgical complications was almost the same across all 3-hour categories of start time. Conclusion: Our study indicates no relation between operation start time and rate of relevant surgical complications following LT. This study is limited by its retrospective nature. A structured prospective study to collect variables to clearly define the relation or no relation between surgical start time and complications is needed.
Publication Year: 2009
Publication Date: 2009-10-01
Language: en
Type: article
Indexed In: ['crossref']
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