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One of the seemingly trivial issues of a patient considering elective plastic surgery is what time of day is my surgery going to be. This is trivial, of course, unless it is you having the surgery. Most patients, unless they have a transportation or scheduling issue, want to be the first surgery of the day. There are many reasons why from a desire to get the operation over without undue time to think about it, not having to wait until after breakfast time due to hunger and they want their surgeon to be as fresh and enthusiastic as possible.

Having a fresh and untired plastic surgeon is an obvious desireable feature on your day of surgery. But is one’s surgical outcome really dependent on what time of day the surgery is done? It would intuitively seem like more surgical ‘mistakes’ are made in the afternoon and evening than in the morning. But is this really true?

In the December issue of Anesthesia and Analgesia, a study from the Cleveland Clinic was published that looked at this very question. Looking at the outcomes of over 32,000 elective surgeries performed from 2005 to 2010, the risk of death within thirty days after surgery was analyzed according to time of day, day of the week and month of the year. Emergent surgeries were eliminated from the study. The study found that the overall risk of death within thirty days after surgery was around 0.4 percent. When adjusted for time of day and day of the week, the findings suggest that the timing of surgery procedures, morning vs afternoon, Monday vs Friday, had no effect on the risk of post-surgery death.

This study shows that fatigue, or the potential for it, did not impact the risk of post-surgery death. While this is certainly comforting for those who don’t have the opportunity to be the first surgical patient of the day, one could also ask what this really has to do with plastic surgery. The complications from the vast majority of plastic surgery procedures is rarely if ever death, but that of undesired aesthetic outcomes and the more routinue problems of bleeding, infection and wound healing issues. Are such problems more likely to occur later in the day than in the morning?

While this study never looked at these issues and it is unlikely any such study in plastic surgery will ever be done, my answer would be no. I have done lots of surgery both early and late in the day. And while one is certainly more likely to be tired at 4PM than 8AM, plastic surgeons are like performers in a theater. (there is a reason why operating rooms used to be called surgical theatres) When the lights go on and the curtain goes up (the patient is prepped and draped), the adrenaline of responsibility and the pride in their work will overcome any amount of fatigue or repetition.

Dr. Barry Eppley

Indianapolis, Indiana

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