Department of Oral and Maxillofacial Surgery, Canberra Hospital, Garran 2605, Australian Capital Territory, Australia.
Int J Oral Maxillofac Surg. 2013 Feb;42(2):214-7. doi: 10.1016/j.ijom.2012.11.001. Epub 2012 Dec 4.
Recent literature from general and orthopaedic surgery as well as anaesthetic viewpoints has identified that operations performed outside normal work hours pose potential risks for both patients and healthcare workers. This is in contrast to the increasing pressure for 24h surgical availability for the public and the desire to reduce waiting times for patients. Further, there is evidence of the effects of fatigue on reducing performance. The authors aim to compare outcomes of maxillofacial trauma surgery performed in and out of normal work hours. Retrospective analysis was carried out on all maxillofacial trauma surgery under general anaesthesia at a tertiary referral hospital over a 14-month period. Outcomes of patient mortality, injury severity, patient demographics and operation duration were analysed with reference to two groups: in-hours (0800-1700 Monday to Friday) and out-of-hours (1700-0800 Monday to Friday as well as all operations performed Saturday and Sunday). 134 patients/procedures met the inclusion criteria, 53 out-of-hours and 81 in-hours. A statistically significant (p=0.05) higher complication rate (13%) was found in the out-of-hours cases compared to the in-hours cases (4%). The potential implications for this result on the need for increased availability of dedicated in-hours maxillofacial trauma operating lists at major hospitals are discussed.
最近来自普通外科和骨科以及麻醉学观点的文献表明，在正常工作时间之外进行的手术对患者和医护人员都存在潜在风险。这与公众对 24 小时手术服务的需求以及减少患者等待时间的愿望形成了鲜明对比。此外，有证据表明疲劳会降低工作表现。作者旨在比较正常工作时间内外进行的颌面创伤手术的结果。对一家三级转诊医院在 14 个月内进行的所有全麻颌面创伤手术进行了回顾性分析。根据两组患者（工作时间内（周一至周五 0800-1700）和工作时间外（周一至周五 1700-0800 以及所有周六和周日进行的手术），分析了患者死亡率、损伤严重程度、患者人口统计学和手术持续时间等结果。符合纳入标准的患者/手术有 134 例，其中 53 例为工作时间外手术，81 例为工作时间内手术。结果发现，工作时间外手术的并发症发生率（13%）明显高于工作时间内手术（4%）（p=0.05）。就这一结果而言，主要医院是否需要增加专门的工作时间内颌面创伤手术清单，这一结果具有潜在影响，因此进行了讨论。
