It may be in your best interest to postpone surgery until regular OR hours. According to a study appearing in The Journal of Bone and Joint Surgery, patients with after-hours operations have 24 percent more unplanned follow-up operations than those who went under the knife during regular office hours.

“Although everyone wants to be treated immediately… it is not always best to rush a patient to the OR in the middle of the night,” explains Dr. William M. Ricci MD, Associate Professor of Orthopaedic Surgery at the Washington University School of Medicine.

The study followed 203 patients who underwent orthopaedic surgery—surgery on bones and joints. While there was no significant difference between radiation exposure, healing time or actual treatment, there was a noticeable disparity between operations that occurred between the daytime and nighttime shifts.

All operations used intramedullary nail fixation to mend tibial or femoral fractures. This is a procedure in which a rod, or “nail”, is used to set the bone. The day was divided into two shifts—the morning shift between 6:00 a.m. and 4:00 p.m., and the night shift thereafter.

Second shift patients had shorter operations, but they also had more follow-up operations and more nail removal surgeries—27percent versus 3 percent for patients whose surgeries occurred during regular office hours. Dr. Ricci believes that much of this can be attributed to the long hours many surgeons put in.

“The reality is that the on-call night surgical team may not be well rested as it is likely they had just finished a normal day shift,” Ricci says. Ricci, who is also chief of the Orthopaedic Trauma Service in the Department of Orthopaedic Surgery at W.U., also explains why non-emergency operations should wait.

“We in the healthcare industry don’t have unlimited resources,” Ricci says. “Many hospitals in the U.S. do have a dedicated night team of orthopaedic surgeons who otherwise are without daytime responsibilities. There are surgical teams on-call for those instances when treatment must be immediate.”

Ricci believes giving orthopaedic surgeons more time to operate on trauma patients can help reduce the risk of minor complications from nail fixation surgeries. He encourages patients to wait for surgery if possible, but insists that actions be taken immediately in urgent situations: “Naturally, when the medical condition is emergent and time is a critical factor, immediate surgery should proceed regardless of time of day.”

Economy class syndrome also known as deep venous thrombosis made news a couple of years ago when a British woman died after a long flight from a blood clot. At the time one question left unanswered was how often this occurs.

In a new study, European researchers calculated the risk to be 1 in 4,656. According to Dr. Samuel Z. Goldhaber, a professor of medicine at Harvard Medical School and director of the Venous Thromboembolism Research Group at Brigham and Women's Hospital in Boston:

This risk is a tiny risk compared with the risk of venous thromboembolism from obesity, severe medical illness, cancer, or surgery.

Deep venous thrombosis is a condition in which a blood clot forms in a vein that is deep inside the body. This can occur if a person stays in the same position for prolonged periods; be it on an airplane, in a car, or on a train.

Signs and symptoms to watch out for while traveling include: leg pain, tenderness or swelling in your leg, and changes in skin color in your leg.

While there are no consistently effective preventive measures, you might try:

• Wearing loose and comfortable clothing
• Walking around as much as possible before your flight
• Moving during the flight– rotate your ankles, flex and point your toes, stand up in your row, or walk the aisles at least every hour

Search Healia for more information on economy class syndrome.

economy class syndrome blood clots deep venous thrombosis