Late operating room start times impact mortality and cost for nonemergent cardiac surgery

Kenan W. Yount, Christine L. Lau, Leora T. Yarboro, Ravi K. Ghanta, Irving L. Kron, John A. Kern, Gorav Ailawadi

Research output: Contribution to journalArticlepeer-review

38 Scopus citations


Background There is growing concern over the effect of starting non-emergent cardiac surgery later in the day on clinical outcomes and resource utilization. Our objective was to determine the differences in patient outcomes for starting non-emergent cardiac surgery after 3 pm. Methods All non-emergent cardiac operations performed at a single institution from July 2008 to 2013 were reviewed. Cases were stratified based on "early start" or "late start," defined by incision time before or after 3 pm. Rates of observed and risk-adjusted mortality, major complications, and costs were compared on a univariate basis for all patients and by multivariable linear and logistic regression for patients with a valid The Society of Thoracic Surgeons (STS) Predicted Risk of Mortality (PROM). Results A total of 3,395 non-emergent cardiac operations were reviewed, including 368 late start cases. Compared with cases starting earlier, mortality was significantly higher for patients undergoing late operations (5.2% vs 3.5%, p = 0.046) despite similar preoperative risk (STS PROM 3.8% vs 3.3%) and major complication rates (18.2% vs 18.3%). Costs were 8% higher with late start cases ($51,576 vs $47,641, p < 0.001). After controlling for case type, surgeon, year, and risk, late cases resulted in higher mortality (odds ratio 2.04, p = 0.041) despite shorter operative duration (16 minutes, p < 0.001). Conclusions Starting non-emergent cardiac cases later in the day is associated with 2 times higher absolute and risk-adjusted mortality. These data should be carefully considered, not only by surgeons and patients but also in the context of the operating room system when scheduling non-emergent cardiac cases.

Original languageEnglish (US)
Pages (from-to)1653-1659
Number of pages7
JournalAnnals of Thoracic Surgery
Issue number5
StatePublished - Nov 2015

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine


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