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Surgery
Research
Surgical quality in organ procurement during day and night: an analysis of quality forms
  1. Jacob de Boer1,2,
  2. Koen Van der Bogt1,3,
  3. Hein Putter4,
  4. Kirsten Ooms-de Vries2,
  5. Bernadette Haase-Kromwijk2,
  6. Robert Pol5,
  7. Jeroen De Jonge6,
  8. Kees Dejong7,
  9. Mijntje Nijboer1,
  10. Daan Van der Vliet8,
  11. Dries Braat1
  1. 1Department of Surgery, Leids Universitair Medisch Centrum, Leiden, Netherlands
  2. 2Nederlandse Transplantatie Stichting, Leiden, The Netherlands
  3. 3Department of Surgery, Medisch Centrum Haaglanden, Den Haag, Zuid-Holland, Netherlands
  4. 4Leids Universitair Medisch Centrum, Statistical Department, Leiden, Netherlands
  5. 5Department of Surgery, Universitair Medisch Centrum Groningen, Groningen, Netherlands
  6. 6Department of Surgery, Erasmus MC, Rotterdam, The Netherlands
  7. 7Department of Surgery, Maastricht Universitair Medisch Centrum+, Maastricht, The Netherlands
  8. 8Department of Surgery, Radboudumc, Nijmegen, The Netherlands
  1. Correspondence to Dr Jacob de Boer; j.d.de_boer{at}lumc.nl

Abstract

Objectives To analyse a potential association between surgical quality and time of day.

Design A retrospective analysis of complete sets of quality forms filled out by the procuring and accepting surgeon on organs from deceased donors.

Setting Procurement procedures in the Netherlands are organised per region. All procedures are performed by an independent, dedicated procurement team that is associated with an academic medical centre in the region.

Participants In 18 months’ time, 771 organs were accepted and procured in The Netherlands. Of these, 17 organs were declined before transport and therefore excluded. For the remaining 754 organs, 591 (78%) sets of forms were completed (procurement and transplantation). Baseline characteristics were comparable in both daytime and evening/night-time with the exception of height (p=0.003).

Primary outcome measure All complete sets of quality forms were retrospectively analysed for the primary outcome, procurement-related surgical injury. Organs were categorised based on the starting time of the procurement in either daytime (8:00–17:00) or evening/night-time (17:00–8:00).

Results Out of 591 procured organs, 129 organs (22%) were procured during daytime and 462 organs (78%) during evening/night-time. The incidence of surgical injury was significantly lower during daytime; 22 organs (17%) compared with 126 organs (27%) procured during evening/night-time (p=0.016). This association persists when adjusted for confounders.

Conclusions This study shows an increased incidence of procurement-related surgical injury in evening/night-time procedures as compared with daytime. Time of day might (in)directly influence surgical performance and should be considered a potential risk factor for injury in organ procurement procedures.

  • surgery
  • risk management
  • transplant surgery
  • quality In health care

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2018-022182

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    Footnotes

    • Contributors JdB, KvdB and DB hypothesised that a relationship may be present between time of day and the incidence of surgical injury. KvdB is involved in the Fit to Perform trial currently performed in The Netherlands. Data on procured organs are provided by all six transplanting centres in the Netherlands to the Dutch Transplant Foundation. Permission to use these was granted by delegates from all centres: RP (Groningen), JdJ (Rotterdam), KD (Maastricht), MN (Leiden) and DvdV (Nijmegen). Data were then obtained via the Dutch Transplant Foundation where KO-dV and BH-K were involved. Data were analysed and statistical analysis was performed and interpreted by JdB, KvdB, DB and HP of the Statistical Department. The manuscript was then drafted by JdB, KvdB, DB and HP. The draft manuscript was critically revised by all involved.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement Data are available on request at the Dutch Transplant Foundation. Permission for this analysis was granted by the national competent authority, the Dutch Transplant Foundation, on 6 April 2017.