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

Abstract

Background: High-volume centers for idiopathic scoliosis (IS) have difficulty in scheduling posterior spinal fusions (PSFs) due to operating room availability, particularly during school vacation. A solution is for 1 surgeon to perform 2 PSF cases back-to-back. This study aims to compare morning and afternoon PSF cases performed by the same surgeon for perioperative outcomes. Methods: A retrospective review of PSF cases for IS that occurred on the same day as another PSF by the same surgeon between January 2013 and December 2019 was conducted. Perioperative outcomes included surgical time, estimated blood loss, length of stay, and inpatient opioid consumption normalized by the patient's weight. Postoperative outcomes included complications, revision rate, curve correction, and patient-reported outcomes using the Scoliosis Research Society-30. Results: A total of 95 patients (87% female), mean age 15.6 years, were analyzed, with 48 morning cases and 47 afternoon cases. The median follow-up was 1.9 years (range: 0.3 to 6.1 y). Tests for equivalency determined equivalence in median anesthesia and mean surgical duration (P = 0.05). The groups had similar initial curve correction (P = 0.43) and rate of complications at 90 days postoperative (2 in each group for a total of 4 complications). No significant differences were seen between Scoliosis Research Society-30 scores at 6 months or in those who have reached 2 years postoperative.Conclusions: Little literature exists on the safety of a surgeon performing 2 PSF cases in 1 day, particularly in regard to pain outcomes, 30-and 90-day complication rates, and quality of life measures. This study indicates that few differences in safety, pain, and quality of life outcomes may appear between morning and afternoon PSF cases. Level of Evidence: Level II.

Two AIS Cases, 2 Surgeons, 1 Operating Room, 1 Day: Faster and Safer Than 1 Case in a Day

“…Other studies suggest no significant change in complications when improving operating room efficiency. [4][5][6]14,15,18,35 This is the first study to show that improving OR efficiency could significantly reduce the frequency of postoperative complications in AIS patients undergoing PSIF. This could be because we used a standardized complication system for orthopaedics, which may have increased the sensitivity of our data collection.…”

“…Various methods have been developed to decrease operating time and meet increasing demands for PSIF. These include scheduling concurrent or overlapping surgeries, [29][30][31] development of dedicated spine surgery teams, 32 single surgeons scheduling morning and afternoon PSIF cases in 1 day, 5,6,33 and 2 fellowship-trained boardcertified attending spine surgeons operating simultaneously on a single AIS patient. [14][15][16][17][18] Though overlapping noncritical portions of orthopaedic surgeries may be safe, 31 patient families 30 and surgeons prefer not to overlap surgeries, particularly the critical portions.…”

“…4 This suggests a large population of AIS patients needing surgical treatment and too few surgeons to provide it. 5 Spine surgeons also face external pressure from institutions to minimize cost and maximize efficiency. 5,6 As postoperative PSIF complication rates range from 5% to 23%, [7][8][9][10] balancing efficiency and quality is of paramount importance when devising strategies to meet these pressures.…”

“…5 Spine surgeons also face external pressure from institutions to minimize cost and maximize efficiency. 5,6 As postoperative PSIF complication rates range from 5% to 23%, [7][8][9][10] balancing efficiency and quality is of paramount importance when devising strategies to meet these pressures. 6 Reducing surgery time directly impacts operating room efficiency and may reduce the risk of complications in spine surgery as well, thus providing increased quality.…”