Heart Surgery Results Better in Afternoon

New research suggests that the time of day actually impacts the long-term effects of surgery. A team of researchers led by David Montaigne of University of Lille-France studied the way patients recovered after complex heart surgery and the effect human circadian rhythms had on their health. Their results were published in October in The Lancet.

A Better Time to Heal

Stat News reports that the team wanted to know if circadian rhythms, the human internal clock, had an impact on the way patients recover from medical procedures. They studied nearly 600 heart valve replacement patients over the span of six years and charted the first 500 days of recovery. Those who had their procedures after noon showed only half the risk of major cardiac events, including acute heart failure and death. In a related study done by the team with a different set of patients having the same surgery, they found a link between afternoon surgeries and lower instances of myocardial ischaemia-reperfusion injury, a type of injury resulting from blood flowing through recently repaired portions of the heart. This type of injury can increase the chances of patient mortality in both the short and long term.

This study is part of a growing body of research into how human circadian rhythms impact patient health. Other treatments that show time-sensitive effects so far include certain vaccines and cancer treatments. Seasonal flu vaccines, for instance, showed signs of higher antibody production when administered before 11am than after 3pm.

Impacts on Care

The article suggested that, while it was probably unrealistic to schedule all heart surgeries in the afternoon, there are ways this data can be used to save lives. Another author of the study, Bart Staels, suggested that high-risk patients could be given the afternoon appointments. Researchers also tested if the heart could be tricked into acting like it was afternoon, thanks to a gene that responds to circadian rhythms called Rev-Erba. They tested mice that had the effects of the gene removed, either through genetic editing or a drug designed to block it, and the mice given surgery during their relative afternoon period showed fewer side effects. Drugs which can have a similar effect on human hearts may help patients recover with fewer side effects regardless of scheduling.

The impacts of this study may not be seen immediately, but hopefully it will serve to reduce the risks of heart and other major surgeries in the near future. Doctors need to take every reasonable precaution to ensure their patients are given the best care at the lowest risk possible. When they don’t, and patients suffer from the effects of medical malpractice, it is vitally important to have an experienced lawyer fighting for the rights of those who suffer.