Commentary: Maybe timing isn't everything!

Central MessageOutcomes in coronary bypass and aortic valve replacement surgery are similar regardless of morning or afternoon case.See Article page 56. Outcomes case. See Commonly, North America, operating rooms perform 2 cases open-heart a day, resulting case an Not infrequently, when our patients told that they will be the (ie, second day), may have concerns regarding potential for surgeon fatigue on performance. Although we often simply reassure their outcome would same whether went afternoon, impact timing patient outcomes is not entirely clear remains controversial. Interestingly, controversy only partly related to team's ability safe operation potentially more patient's circadian rhythm reperfusion injury after cardiopulmonary bypass. In addition, recent work published Journal by Huard colleagues1Huard P. Kalavrouziotis D. Lipes J. Simon M. Tardif M.A. Blackburn S. et al.Does full-time presence intensivist lead better cardiac surgical intensive care unit?.J Thorac Cardiovasc Surg. May 11, 2019; ([Epub ahead print])Abstract Full Text PDF PubMed Scopus (7) Google Scholar also showed 24-hour coverage unit led than units were managed intensivists during day (with residents fellows covering evening). Thus, there several factors as it relates start surgery. Lancet, Montaigne colleagues2Montaigne Marechal X. Modine T. Coisne A. Mouton Fayad G. al.Daytime variation perioperative myocardial its prevention Rev-Erbα antagonism: single-centre propensity-matched cohort study randomised study.Lancet. 2018; 391: 59-69Abstract (131) from Lille, France, increase major adverse events propensity score–matched 298 pairs undergoing (AVR) those compared with The randomized 88 isolated AVR found greater levels troponin release group and, taken together, these findings suggest maybe protective AVR. Conversely, no evidence harm has been demonstrated studies involving artery grafting. Indeed, 18,000 Cleveland Clinic time had early following surgery.3Tan P.J. Xu Sessler D.I. Bashour C.A. Operation does affect graft surgery.Anesthesiology. 2009; 111: 785-789Crossref (33) Nonetheless, intriguing this Lancet publication prompted further evaluation other groups, leading Nemeth colleagues4Nemeth Schnell Argenziano Ning Y. Kurlansky Daytime surgery: results diverse, multi-institutional network.J 2021; 162: 56-67.e44Abstract (6) issue Journal. Using data gathered Society Thoracic Surgeons Adult Cardiac Surgery Database 11 centers Columbia HeartSource program, 3:1 score matching was performed create population (defined starting between 06:30 09:00 AM) noon 2:30 PM) For grafting (5830 AM 1961 PM patients), difference operative mortality morbidity (stroke, prolonged postoperative ventilation, renal failure, deep sternal wound infection, reoperation). These replicated 1645 613 Importantly, authors controlled institutional effects including hospital independent random sensitivities analyses using hierarchical modeling. However, current paper must interpreted context some significant limitations, which discussed paper. Despite use extensive list variables, treatment allocation bias unmeasured/unknown confounders, results. slots prioritized reasons captured dataset. example, at institution, longer complicated scheduled so finishes rather late evening. While overall, groups fairly well balanced match, ethnicity, particular, proportions Hispanics patients, remained different cohort. subgroup analysis Hispanic outcome, note underpowered detect differences event rates low. Furthermore, lacked serum measurements biomarkers associated homeostasis—such cortisol secretion. contrast French group, markers included informative. mainly focused patient-related outcomes; surgeon-related performance assessed explicitly. congratulated conducting important study. odds recently multicenter nature along strong statistical methods employ robust assignment either unlikely effect patients. Results networkThe Cardiovascular SurgeryVol. 162Issue 1PreviewRecent single-center experimental suggested (AM) versus (PM). previous (CABG) time-related difference. We examined CABG network January 2008 September 2018. Full-Text