Here's a scenario for your consideration. Let's hypothesize that you are scheduled for elective surgery shortly. You have sought a second opinion and the surgery has been deemed necessary and appropriate (see: Cleveland Clinic TV Advertisement: Get a Second Opinion in Cardiology). You have made inquiries and your surgeon is well trained and has performed your procedure numerous times with the same team. You are in relatively good health, have a normal weight, and are a non-smoker so you do not anticipate any significant post-operative complications. You have health insurance and the cost of your procedure will be covered. Anything else to think about? Well, you might ask about the time of day when your surgery is scheduled. If it's a "follow case" that will be started late in the day, you may be increasing your risk (see: Night Time Surgery 'Doubles Death Risk). Below is an excerpt from this article:
People who undergo surgery at night are twice as likely to die as those operated on during regular daytime hours....The findings...also suggest a higher than usual risk of death among those who have surgery later in the day and in the early evening. The results are based on studying 30-day survival rates for patients at a hospital in Montreal, Canada. Between April 2010 and March 2015, the researchers were able to compile a database of 41,716 emergency and routine operations carried out on 33,942 patients.The operations were classified as taking place either in the daytime between 7.30 am and 3.29 pm; during the evening between 3.30 pm and 11.29 pm; or at night between 11.30 pm and 7.29 am.The researchers found that, after making allowances for assessment of patients' overall health and other factors such as age, those patients operated on in the night were 2.17 times more likely to die than those operated on during regular daytime working hours. Also, patients operated on late in the day were 1.43 times more likely to die than those operated on during regular daytime working hours. The researchers say there may be a number of reasons for why night time surgery is more risky. These include fatigue among medical staff, overnight staffing shortages or treatment delays.
Scheduling operating room procedures across multiple rooms is a daunting task. Emergency procedures or an overlong operation due to complications can play havoc with the schedule. The same is true for medical procures such as colonoscopies. The findings of the research cited above that there is more risk when surgery is performed later in the day stands to reason. The nerves of surgeons and nurses can get frazzled as the day progresses and this may have an effect on performance.
Generally speaking, elective surgeries are scheduled early in the day. However and particularly at large referral centers with a high surgical volume, there may be a long queue of elective surgeries that lasts until late in the day. It occurred to me that there may be an apt analogy between elective surgery slots and airplane seats. Perhaps it could be possible to reserve an early start time for a patient with "frequent flier" status similar to the most desirable seats in the plane. Just something to think about for hospital executives. Of course, they would not relish the idea that some of their patients are disadvantaged in any way for surgeries that start later in the day.