Skip to main content


Log in

Day and night surgery: is there any influence in the patient postoperative period of urgent colorectal intervention?

  • Original Article
  • Published:
International Journal of Colorectal Disease Aims and scope Submit manuscript



Medical activity performed outside regular work hours may increase risk for patients and professionals. There is few data with respect to urgent colorectal surgery. The aim of this work was to evaluate the impact of daytime versus nighttime surgery on postoperative period of patients with acute colorectal disease.


A retrospective study was conducted in a sample of patients with acute colorectal disease who underwent urgent surgery at the General Surgery Unit of Braga Hospital, between January 2005 and March 2013. Patients were stratified by operative time of day into a daytime group (surgery between 8:00 and 20:59) and the nighttime group (21:00–7:59) and compared for clinical and surgical parameters. A questionnaire was distributed to surgeons, covering aspects related to the practice of urgent colorectal surgery and fatigue.


A total of 330 patients were included, with 214 (64.8 %) in the daytime group and 116 (35.2 %) in the nighttime group. Colorectal cancer was the most frequent pathology. Waiting time (p < 0.001) and total length of hospital stay (p = 0.008) were significantly longer in the daytime group. There were no significant differences with respect to early or late complications. However, 100 % of surgeons reported that they are less proficient during nighttime.


Among patients with acute colorectal disease subjected to urgent surgery, there was no significant association between nighttime surgery and the presence of postoperative medical and surgical morbidities. Patients who were subjected to daytime surgery had longer length of stay at the hospital.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others


  1. Kohn LT, Corrigan J, Donaldson MS (2000) To err is human: building a safer health system. National Academy Press, Washington, DC

    Google Scholar 

  2. Lee KT, Mun GH (2013) Is after-hours free-flap surgery associated with adverse outcomes? J Plast Reconstr Aesthet Surg 66:460–466

    Article  PubMed  Google Scholar 

  3. Bertram A, Hyam D, Hapangama N (2013) Out-of-hours maxillofacial trauma surgery: a risk factor for complications? Int J Oral Maxillofac Surg 42:214–217

    Article  CAS  PubMed  Google Scholar 

  4. Griner D, Adams A, Kotwall CA et al (2011) After-hours urgent and emergent surgery in elderly: outcomes and prognostic factors. Am Surg 77:1021–1024

    PubMed  Google Scholar 

  5. Owens JA (2001) Sleep loss and fatigue in medical training. Curr Opin Pulm Med 7:411–418

    Article  CAS  PubMed  Google Scholar 

  6. Landrigan CP, Rothschild JM, Cronin JW et al (2004) Effect of reducing interns’ work hours on serious medical errors in intensive care units. N Engl J Med 351:1838–1848

    Article  CAS  PubMed  Google Scholar 

  7. Eastbridge BJ, Hamilton EC, O’Keefe GE et al (2003) Effect of sleep deprivation on the performance of simulated laparoscopic surgical skill. Am J Surg 186:169–174

    Article  Google Scholar 

  8. O’Loughlin E, Smithies WJ, Corcoran TB (2010) Out-of-hours surgery-a snapshot in time. Anaesth Intensive Care 38:1059–1063

    PubMed  Google Scholar 

  9. Gray A (2000) United Kingdom national confidential enquiry into perioperative deaths. Minerva Anestesiol 66:288–292

    CAS  PubMed  Google Scholar 

  10. Fechner G, Pezold C, Hauser S et al (2008) Kidney’s nightshift, kidney’s nightmare? Comparison of daylight and nighttime kidney transplantation: impact on complications and graft survival. Transplant Proc 40:1341–1344

    Article  CAS  PubMed  Google Scholar 

  11. Faiz O, Banerjee S, Tekkis P et al (2007) We still need to operate at night! World J Emerg Surg 2:29

    Article  PubMed  PubMed Central  Google Scholar 

  12. Novack V, Jotkowitz A, Etzion O et al (2007) Does delay in surgery after hip fracture lead to worse outcomes? A multicenter survey. Int J Qual Health Care 19:170–176

    Article  PubMed  Google Scholar 

  13. George TJ, Arnaoutakis GJ, Merlo CA et al (2011) Association of operative time of day with outcomes after thoracic organ transplant. JAMA 305:2193–2199

    Article  CAS  PubMed  Google Scholar 

  14. Kienzl-Wagner K, Schneiderbauer S, Bösmüller C et al (2013) Nighttime procedures are not associated with adverse outcomes in kidney transplantation. Transpl Int 26:879–885

    Article  PubMed  Google Scholar 

  15. Rashid RH, Zubairi AJ, Slote MU et al (2013) Hip fracture surgery: does time of the day matter? A case-controlled study. Int J Surg 11(9):923–925

    Article  PubMed  Google Scholar 

  16. Dorotka R, Schoechtner H, Buchinger W (2003) Influence of nocturnal surgery on mortality and complications in patients with hip fractures. Unfallchirurg 106:287–293

    Article  CAS  PubMed  Google Scholar 

  17. Komen N, Dijk JW, Lalmahomed Z et al (2009) After-hours colorectal surgery: a risk factor for anastomotic leakage. Int J Color Dis 24:789–795

    Article  Google Scholar 

  18. Eishove-Bolk J, Ellensen VS, Baatrup G (2010) Logistics and outcome in urgent and emergency colorectal surgery. Color Dis 12:255–259

    Article  Google Scholar 

  19. Biondo S, Pares D, Marti Rague J et al (2002) Emergency operations for nondiverticular perforation of the left colon. Am J Surg 183:256–260

    Article  PubMed  Google Scholar 

  20. Lee YM, Law WL, Chu KW et al (2001) Emergency surgery for obstructing colorectal cancers: a comparison between rightsided and left-sided lesions. J Am Coll Surg 192:719–725

    Article  CAS  PubMed  Google Scholar 

  21. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213

    Article  PubMed  PubMed Central  Google Scholar 

  22. Eddy R (2005) Sleep deprivation among physicians. Arch Surg 47:176–180

    Google Scholar 

  23. McCormick F, Kadzielski J, Landrigan CP et al (2012) Surgeon fatigue: a prospective analysis of the incidence, risk, and intervals of predicted fatigue-related impairment in residents. Arch Surg 147:430–435

    Article  PubMed  Google Scholar 

  24. Bonnet MH (2000) Sleep deprivation. In: Kryger MH, Roth T, Dement WC (eds) Principles and practice of sleep Medicin, 3rd edn. Saunders, Philadelphia, p 53

    Google Scholar 

  25. Brandenberger J, Kahol K, Feinstein AJ et al (2010) Effects of duty hours and time of day on surgery resident proficiency. Am J Surg 200:814–818

    Article  PubMed  Google Scholar 

  26. ACSS. Novo Quadro Legal da Carreira Médica e Organização do Tempo de Trabalho Médico. [ACSS web site]. Apr 19, 2013. Available at: dica_FAQ-2013-04-19_final.pdf. Accessed Nov 08, 2013

  27. Zorcolo L, Covotta L, Carlomagno N et al (2003) Toward lowering morbidity, mortality and stoma formation in emergency colorectal surgery: the role of specialization. Dis Colon Rectum 46:1461–1467

    Article  PubMed  Google Scholar 

  28. Biondo S, Kreisler E, Millan M et al (2010) Impact of surgical specialization on emergency colorectal surgery outcomes. Arch Surg 145:79–86

    Article  PubMed  Google Scholar 

  29. Biondo S, Parés D, Frago R et al (2004) Large bowel obstruction: predictive factors for postoperative mortality. Dis Colon Rectum 47:1889–1897

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Pedro Leão.

Ethics declarations

Conflict of interest

The authors declare that they do not have conflicts of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Fernandes, S., Carvalho, A.F., Rodrigues, A.J. et al. Day and night surgery: is there any influence in the patient postoperative period of urgent colorectal intervention?. Int J Colorectal Dis 31, 525–533 (2016).

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: