After-hours elective spine deformity corrective surgery for patients with Adolescent Idiopathic Scoliosis: Is it safe?

Abstract

Objective: The aim of this study was to compare the outcome of after-hours electively planned Posterior Spinal Fusion surgeries for Adolescent Idiopathic Scoliosis (AIS) patients with daytime surgeries. Methods: This was a retrospective propensity score-matched study using prospectively collected data. Surgeries performed between 08:00 and 16:59 h were labeled as daytime surgeries (group 1) and surgeries performed between 17:00 and 06:00 h were labeled as after-hours surgeries (group 2). The perioperative outcome parameters were average operation time in and out, operation duration, intraoperative blood loss, blood transfusion, intraoperative hemodynamic parameters, preoperative hemoglobin, postoperative hemoglobin, and total patient-controlled anesthesia (PCA) morphine usage. Radiological variables assessed were Lenke subtypes, preoperative Cobb angle, number of fusion levels, number of screws used, postoperative Cobb angle, correction rate, side bending flexibility, side bending correction index, complications rate, and length of hospitalization. Results: Average operation time in for daytime group was 11:32 + 2:33 h versus 18:20 + 1:05 h in after-hours group. Comparing daytime surgeries with after-hours surgeries, there were no significant differences (p > 0.05) in the operation duration, intraoperative blood loss, intraoperative pH, bicarbonate, lactate, postoperative hemoglobin, hemoglobin drift, blood transfusion, postoperative Cobb angle, correction rate, side bending flexibility, side bending correction index, length of hospitalization, and complications rate. Total PCA morphine usage was significantly lesser in the after-hours group (18.2 + 15.3 mg) compared with the daytime group (24.6 + 16.6 mg; p ¼ 0.042). Conclusions: After-hours elective spine deformity corrective surgeries for healthy ambulatory patients with AIS were as safe as when they were done during daytime.

Outcome of after-hours surgery: Setting, skill and timing may explain the outcome

“…The authors performed a propensity score matching using patients' and surgical characteristics and created two groups according to the time of surgery (08:00-16:59 daytime; 17:00-06:00 after-hours). 1 They did not find any difference in terms of surgical outcome, intraoperative blood loss and length of hospitalization. The authors concluded that this type of surgery performed during after-hours is as safe as during daytime.…”

Letters about Published Papers

“…Our study investigated a specific subset of adolescent idiopathic scoliosis (AIS) patients who had planned elective posterior spinal fusion (PSF) surgeries and not emergency surgeries. 2 Moreover, our patients had surgeries done by a dedicated spine team involving the same surgeons, anaesthetist, radiographers, nurses and assistants. Therefore, the aim of our study and the patient population of our study were not similar to the study done by Cortegiani et al…”