University of Michigan Medical School, Ann Arbor, Michigan.
Department of Neurology, University of Michigan Health System, Ann Arbor, Michigan.
Neurosurgery. 2018 Sep 1;83(3):501-507. doi: 10.1093/neuros/nyx485.
Neurosurgical procedures are necessary at all times of day. Other surgical specialties have examined the effect of surgical start time (SST) on morbidity and mortality; however, a similar study has not been performed for neurosurgical procedures.
To perform a retrospective cohort study describing the association between SST and operative morbidity.
We analyzed all patients undergoing neurological surgery between January 1, 2007 and August 1, 2014 at our institution. This study included 15 807 patients. A total of 785 complications were identified through the self-reported morbidity and mortality reports created by faculty and resident neurosurgeons. We used multilevel logistic regression to investigate the association of SST with morbidity.
In multilevel logistic regression, our Baseline model demonstrated that the odds of complication increased by more than 50% for start times between 21:01 and 07:00 (odds ratio [OR] 1.53, 95% confidence interval [CI] 1.03-2.29, P = .04). When accounting for the length of the surgery, the odds of a complication were even greater for later time periods 21:01 to 07:00 (OR 2.16, 95% CI 1.44-3.23, P < .001). The only statistically significant factor that predicted severity of the complication was if the operation was emergent compared to elective (OR 1.70, 95% CI 1.11-2.60, P = .02). An SST between 21:01 and 07:00 substantially contributed when severe complications were isolated (OR 1.61, 95% CI 1.50-2.90, P = .08).
Patients with SSTs between 21:01 and 07:00 are at an increased risk of developing morbidity compared to patients with an SST earlier in the day.
神经外科手术在一天中的任何时候都需要进行。其他外科专业已经研究了手术开始时间（SST）对发病率和死亡率的影响；然而，尚未对神经外科手术进行类似的研究。
进行回顾性队列研究，描述 SST 与手术发病率之间的关系。
我们分析了 2007 年 1 月 1 日至 2014 年 8 月 1 日期间在我院接受神经外科手术的所有患者。这项研究共包括 15807 名患者。通过教师和住院神经外科医生创建的自我报告发病率和死亡率报告，共发现 785 例并发症。我们使用多水平逻辑回归来研究 SST 与发病率的关系。
在多水平逻辑回归中，我们的基线模型表明，手术开始时间在 21:01 至 07:00 之间时，并发症的几率增加了 50%以上（比值比 [OR] 1.53，95%置信区间 [CI] 1.03-2.29，P =.04）。当考虑手术时间长短时，21:01 至 07:00 这段时间的并发症几率甚至更高（OR 2.16，95% CI 1.44-3.23，P<.001）。唯一预测并发症严重程度的统计学显著因素是手术是紧急手术还是择期手术（OR 1.70，95% CI 1.11-2.60，P =.02）。当严重并发症孤立发生时，SST 在 21:01 至 07:00 之间的时间显著增加（OR 1.61，95% CI 1.50-2.90，P =.08）。
与当天早些时候相比，SST 在 21:01 至 07:00 之间的患者发生发病率的风险增加。
