‘After-hours’ non-elective spine surgery is associated with increased perioperative adverse events in a quaternary center

Abstract

Purpose 'After-hours' non-elective spinal surgeries are frequently necessary, and often performed under sub-optimal conditions. This study aimed (1) to compare the characteristics of patients undergoing non-elective spine surgery 'After-hours and (2) to compare the perioperative adverse events (AEs) between those undergoing non-elective spine surgery 'after-hours' as compared to 'in-hours'. Methods In this retrospective study of a prospective non-elective spine surgery cohort performed in a quaternary spine center, surgery was defined as 'in-hours' if performed between 0700 and 1600 h from Monday to Friday or 'after-hours' if more than 50% of the operative time occurred between 1601 and 0659 h, or if performed over the weekend. The association of 'after-hours' surgery with AEs, surgical duration, intraoperative estimated blood loss (IOBL), length of stay and in-hospital mortality was analyzed using stepwise multivariate logistic regression. Results A total of 1440 patients who underwent non-elective spinal surgery between 2009 and 2013 were included in this study. A total of 664 (46%) procedures were performed 'after-hours'. Surgical duration and IOBL were similar. About 70% of the patients operated 'after-hours' experienced at least one AE compared to 64% for the 'in-hours' group (p = 0.016). 'After-hours' surgery remained an independent predictor of AEs on multivariate analysis [adjusted OR 1.30, 95% confidence interval (CI) 1.02-1.66, p = 0.034]. In-hospital mortality increased twofold in patients operated 'after-hours' (4.4% vs. 2.1%, p = 0.013). This association lost significance on multivariate analysis (adjusted OR 1.99, 95% CI 0.98-4.06, p = 0.056). Conclusion Non-elective spine surgery performed 'after-hours' is independently associated with increased risk of perioperative adverse events, length of stay and possibly, mortality. Research is needed to determine the specific factors contributing to poorer outcomes with 'after-hours' surgery and strategies to minimize this risk.

Out-of-hours versus in-hours delivery of antenatally diagnosed transposition of the great arteries: outcomes from a United Kingdom Tertiary Centre

“…This is further evidenced by other studies of out-of-hours work in spinal surgery and intensive care. 10,11 Multiple previous studies have demonstrated the advantages of antenatal diagnosis in ensuring optimal postnatal management and improved survival. Bonnet et al reported on 318 neonates with transposition of the great arteries and observed significantly higher mortality for postnatally diagnosed neonates (14% versus 0% antenatally diagnosed).…”

Performing Multiple Posterior Spinal Fusions in 1 Day: A Comparison of Perioperative Outcomes Between Morning and Afternoon Cases

“…However, concerns have been raised in both popular and peer-reviewed literature regarding the safety of multiple intensive procedures performed by the same surgeon in 1 day. [9][10][11][16][17][18]27,28 Although little literature exists regarding the safety of multiple pediatric spine procedures in 1 day, 2 recent studies has found equivalent safety outcomes between morning and afternoon PSF procedures. 5 Our current study builds upon previous case series with a further discussion of pain outcomes, including patient-reported pain scores and inpatient opioid usage, as well as longer term follow-up.…”

“…[13][14][15] Within orthopaedic surgery, most studies have focused on trauma cases occurring "after-hours" (evening and night) and disagree on outcomes. [16][17][18][19][20][21][22][23] Only 1 of these studies considered the pediatric population, comparing outcomes of supracondylar humeral fractures with poorer outcomes associated with after-hours treatment. 18 Charest-Morin et al 16 focused on nonelective spine trauma cases and found that after-hours timing was associated with poorer outcomes.…”

“…[16][17][18][19][20][21][22][23] Only 1 of these studies considered the pediatric population, comparing outcomes of supracondylar humeral fractures with poorer outcomes associated with after-hours treatment. 18 Charest-Morin et al 16 focused on nonelective spine trauma cases and found that after-hours timing was associated with poorer outcomes. However, the results of these studies could be explained by staff fatigue much later in the day and more severe injuries occurring after-hours.…”

Association Between Daytime vs Overnight Digit Replantation and Surgical Outcomes

“…We conducted a retrospective case series study at a tertiary care academic center to assess surgical time, categorized as either daytime or overnight, and replantation outcomes. We investigated surgical timing and replantation outcomes using previously described time intervals 20,22,[26][27][28][29][30]32,37,41,[43][44][45][46][47][48][49] and adjusted for both procedure difficulty and surgeon skill. 50 We hypothesized that there would be no difference in digit survival, complication rates, and surgery duration between daytime and overnight digit replantations.…”