Department of Neurosurgery, Cambridge University Hospitals, Cambridge, UK.
Department of Neurosurgery, Sheffield Teaching Hospitals, Sheffield, UK.
Acta Neurochir (Wien). 2022 May;164(5):1203-1208. doi: 10.1007/s00701-022-05173-2. Epub 2022 Mar 2.
To investigate the incidence of complications from lumbar decompression ± discectomy surgery for cauda equina syndrome (CES), assessing whether time of day is associated with a change in the incidence of complications.
Electronic clinical and operative notes for all lumbar decompression operations undertaken at our institution for CES over a 2-year time period were retrospectively reviewed. "Overnight" surgery was defined as any surgery occurring between 18:00 and 08:00 on any day. Clinicopathological characteristics, surgical technique, and peri/post-operative complications were recorded. Multivariable logistic regression was used to calculate odds ratios (OR) and 95% confidence intervals.
A total of 81 lumbar decompression operations were performed in the 2-year period and analysed. A total of 29 (36%) operations occurred overnight. Complete CES (CESR) was seen in 13 cases (16%) in total, 7 of whom underwent surgery during the day. Exactly 27 complications occurred in 24 (30%) patients. The most frequently occurring complication was a dural tear (n = 21, 26%), followed by post-operative haematoma, infection, and residual disc. Complication rates in the CESR cohort (54%) were significantly greater than in the CES incomplete (CESI) cohort (25%) (p = 0.04). On multivariable analysis, overnight surgery was independently associated with a significantly increased complication rate (OR 2.83, CI 1.02-7.89).
Lumbar decompressions performed overnight for CES were more than twice as likely to suffer a complication, in comparison to those performed within daytime hours. Our study suggests that out-of-hours operating, particularly at night, must be clinically justified and should not be influenced by day-time operating capacity.
调查马尾综合征（CES）减压和椎间盘切除术术后并发症的发生率，评估手术时间是否与并发症发生率的变化有关。
回顾性分析了我院在 2 年内所有因 CES 而行腰椎减压手术的电子临床和手术记录。“夜间”手术定义为任何在一天中的 18:00 至 08:00 之间进行的手术。记录临床病理特征、手术技术以及围手术期并发症。采用多变量逻辑回归计算比值比（OR）和 95%置信区间。
在 2 年期间共进行了 81 例腰椎减压手术，其中 29 例（36%）为夜间手术。总共 13 例（16%）患者出现完全 CES（CESR），其中 7 例在日间接受手术。24 例（30%）患者中出现 27 例并发症。最常见的并发症是硬脊膜撕裂（n=21，26%），其次是术后血肿、感染和残留椎间盘。CESR 组（54%）的并发症发生率明显高于 CES 不完全组（25%）（p=0.04）。多变量分析显示，夜间手术与并发症发生率显著增加独立相关（OR 2.83，CI 1.02-7.89）。
与日间手术相比，CES 夜间减压手术发生并发症的风险增加了两倍以上。我们的研究表明，夜间手术（尤其是夜间）必须有临床依据，而不应受日间手术能力的影响。
