OR in the News

Full moons, late afternoons, Fridays won’t faze your doctor

September 29, 2009 By Rita Rubin, USA TODAY

Is it safer to have elective surgery first thing in the morning rather than in late afternoon, when doctors and nurses might be tired? For the same reason, is it smarter to schedule surgery earlier in the workweek than later?

And is it better to avoid having elective surgery in July and August, when a new crop of residents has just started training?

Also, is it foolish to have elective surgery when the moon is full and, tradition has it, people can go a little off-kilter? No, no, no and no, according to a Cleveland Clinic study that found timing isn’t anything, at least when it comes to elective coronary bypass surgery.

The authors of the study, published today in the journal Anesthesiology, write that they decided to focus on elective heart bypass surgery because, thanks to “well-established protocols (for bypass surgery), there is much less variability than with other procedures.” Plus, they write, “hospitals closely track morbidity and mortality for this operation.”

Daniel Sessler, an anesthesiologist who chairs the Cleveland Clinic’s department of outcomes research, says he and his co-authors hope to examine whether timing affects other types of elective surgery, but they expect to find the same thing.

The researchers analyzed the results of 18,597 elective bypass surgeries at the Cleveland Clinic from 1993 to 2006. Most were performed between 7 a.m. and 5 p.m. on weekdays. None of the time factors — hour, day, month or phase of moon — made any difference in the outcomes of the operations.

“Fatigue is well-known to impair performance,” Sessler says, citing its role in plane and car crashes. “It’s highly plausible that fatigue would impair performance of medical personnel.”

But, he says, just because doctors or nurses are fatigued and make mistakes doesn’t necessarily mean patients suffer. “Hospitals have extensive systems in place to minimize the consequences of any error,” he says.

The Cleveland Clinic team isn’t the first to look at whether the phases of the moon are linked to behavior or health. Even Shakespeare wrote in Othello: “It is the very error of the moon: She comes more nearer Earth than she was wont; And makes men mad. � ”

Strangely, at least two studies published last year did find a connection, although the authors were at a loss to explain why:

• A Brazilian study of unexpected deaths in one hospital’s epilepsy unit found that over an eight-year period, 70% occurred when the moon was full.
• Scottish researchers found that more patients were admitted to their hospital with medically unexplained stroke symptoms when the moon was full than during other lunar phases. But an Austrian study of 65,000 suicides over a quarter of a century found no connection with the phases of the moon.