First Operation of the Day May Be Associated with Worse Patient Outcomes

Dagnino F, Polazzi S, Lifante J, Dey T, et al. Influence of the Surgeon’s First Operation of the Day on Patient Outcomes. Ann Surg. July 2026.

The impact of daily operating room workload on a surgeon’s performance and patient outcomes is uncertain. Authors of this article investigated whether the cumulative operative time spent by a surgeon operating on patients on the same day before starting a new procedure was associated with surgical outcomes.

All elective patients, operated by attending surgeons across seven specialties in four French hospitals between November 1, 2020 and December 31, 2021, were included. Surgeons’ operative workload the same day before each operation was measured in minutes by cumulating incision-to-closure times for all their patients as the primary operator. 

A composite of adverse events within 30 days post-surgery encompassed major surgical complications, unplanned reoperation, extended intensive care unit (ICU) stay, and patient death. Generalized linear mixed models estimated the association between each outcome and operative workload, considering the clustering of operations by surgeons, and adjusting for patient comorbidities, procedure complexity, and surgeon characteristics.

The cohort included 7,979 elective surgeries performed by 44 surgeons. Composite adverse event rates were higher in the 0-minute group compared with those with a higher duration (20.7% versus 12.5%, P < 0.001), as were rates of major complications (19.3% versus 11.7%, P < 0.001), reoperations (6.5% versus 3.4%, P = 0.005), and ICU stay (3.7% vs 1.2%, P = 0.016). When the surgeon had already spent time operating on patients before the procedure, adjusted relative risks were lower for composite adverse events [adjusted relative risk: 0.85 (95% CI: 0.76 to 0.95)], major complications [0.86 (0.76 to 0.97)], reoperation [0.78 (0.63 to 0.97)], and ICU stay [0.69 (0.49 to 0.98)].

For surgeons, this study suggests that the first patient of the day may experience worse outcomes, prompting surgeons to warm up before starting surgery. Further research is needed to confirm these findings, as surgeons may intentionally schedule their most complex or challenging cases as the first procedure of the day.