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06.12.2018 | Original Article | Ausgabe 4/2019

European Spine Journal 4/2019

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

Zeitschrift:
European Spine Journal > Ausgabe 4/2019
Autoren:
Raphaële Charest-Morin, Alana M. Flexman, Michael Bond, Tamir Ailon, Nicolas Dea, Marcel Dvorak, Brian Kwon, Scott Paquette, Charles G. Fisher, John Street
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s00586-018-5848-x) contains supplementary material, which is available to authorized users.

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’ as compared to ‘In-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.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.

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