Santangelo Gabrielle, Ellens Nathaniel, Singh Aman, Hoang Ricky, Susa Stephen, Molinari Robert, Mattingly Thomas
Department of Neurosurgery, University of Rochester Medical Center, Rochester, NY, USA
Department of Neurosurgery, University of Rochester Medical Center, Rochester, NY, USA.
Int J Spine Surg. 2023 Aug;17(4):564-569. doi: 10.14444/8480. Epub 2023 Jul 24.
Spinal injuries, whether mechanical or neurological, frequently require urgent intervention. Superior outcomes are associated with earlier intervention, which often requires operating overnight and on weekends. However, operating after hours has been associated with increased risks of complications in selected studies. The authors sought to determine whether there are differences in outcomes for "after hours" surgery compared with "during hours" surgery for spinal emergencies.
This is a single-center retrospective cohort study of spine surgery patients who underwent urgent surgery within 6 hours, from January 2015 through December 2019. Surgery was considered during hours if it started between 8 am and 5 pm Monday through Friday. After hours was defined as from 5 pm through 8 am on a weekday or Saturday or Sunday. We assessed 30-day outcome measures for differences between operations performed during hours or after hours.
There were 241 spine procedures performed (49 during hours and 192 after hours). There was no significant difference between the length of operation (145.3 vs 129.8 minutes, = 0.29), estimated blood loss (303.9 vs 274.4 mL, = 0.61), improvement in American Spinal Injury Association scale (0.26 vs 0.24 grade, = 0.85), 30-day return to the operating room (OR; 14.3% vs 6.8%, = 0.09), 30-day readmission (2.0% vs 6.3% = 0.24), intensive care unit length of stay (4.6 vs 6.3 days, = 0.27), hospital length of stay (13.5 days vs 14.2 days, = 0.72), or 30-day mortality (4.1% vs 7.3%, = 0.42) for cases performed during hours compared with those after hours, respectively. On multivariate analysis, prior malignancy ( = 0.008) and blue immediate status ( = 0.004) were predictors of 30-day mortality. However, "after hours" surgery was not a predictor of 30-day return to the OR, readmission, or mortality in either univariate or multivariate analysis.
Spine surgery must often be performed after hours. However, the time of day does not significantly impact the 30-day outcomes for emergent spine surgery.
脊柱损伤，无论是机械性还是神经性的，通常都需要紧急干预。更好的治疗结果与更早的干预相关，而这往往需要在夜间和周末进行手术。然而，在一些研究中，非工作时间进行手术与并发症风险增加有关。作者试图确定脊柱急诊“非工作时间”手术与“工作时间”手术的结果是否存在差异。
这是一项单中心回顾性队列研究，研究对象为2015年1月至2019年12月期间在6小时内接受紧急手术的脊柱手术患者。如果手术在周一至周五上午8点至下午5点之间开始，则被视为工作时间手术。非工作时间定义为工作日下午5点至上午8点或周六、周日。我们评估了工作时间或非工作时间进行的手术之间30天的结果指标差异。
共进行了241例脊柱手术（工作时间手术49例，非工作时间手术192例）。工作时间手术与非工作时间手术相比，手术时长（145.3分钟对129.8分钟，P = 0.29）、估计失血量（303.9毫升对274.4毫升，P = 0.61）、美国脊髓损伤协会量表改善情况（0.26级对0.24级，P = 0.85）、30天返回手术室情况（14.3%对6.8%，P = 0.09）、30天再入院情况（2.0%对6.3%，P = 0.24）、重症监护病房住院时长（4.6天对6.3天，P = 0.27）、住院时长（13.5天对14.2天，P = 0.72）或30天死亡率（4.1%对7.3%，P = 0.42）均无显著差异。多因素分析显示，既往恶性肿瘤（P = 0.008）和蓝色紧急状态（P = 0.004）是30天死亡率的预测因素。然而，在单因素或多因素分析中，“非工作时间”手术均不是30天返回手术室、再入院或死亡率的预测因素。
脊柱手术常常必须在非工作时间进行。然而，一天中的时间对急诊脊柱手术的30天结果并无显著影响。
