Ellens Nathaniel R, Susa Stephen, Hoang Ricky, Love Tanzy, Jones Jeremiah, Santangelo Gabrielle, Bender Matthew T, Mattingly Thomas K
Department of Neurosurgery, University of Rochester, Rochester, New York, USA.
University of Rochester School of Medicine & Dentistry, Rochester, New York, USA.
World Neurosurg. 2024 Jan;181:e703-e712. doi: 10.1016/j.wneu.2023.10.116. Epub 2023 Oct 26.
Surgery performed at night and on weekends is thought to be associated with increased complications. However, the impact of time of day on outcomes has not been studied within cranial neurosurgery. We aim to determine if there are differences in outcomes for cranial neurosurgery performed after hours (AH) compared with during hours (DH).
We performed a single-center retrospective study of cranial neurosurgery patients who underwent emergent surgery from January 2015 through December 2019. Surgery was considered DH if the incision occurred between 8 am and 5 pm Monday through Friday. We assessed outcome measures for differences between operations performed DH or AH.
Three-hundred and ninety-three patients (114 DH, 279 AH) underwent surgery. There was a lower rate of return to the operating room within 30 days for AH (8.6%) compared with DH (14.0%), P = 0.03, on multivariate analysis. There were no significant differences in length of operation, estimated blood loss, improvement in Glasgow Coma Scale, intensive care unit and total hospital length of stay, 30-day readmission, 30-day mortality, and in-hospital mortality for cases performed DH compared with AH. Further subgroup analyses were performed for patients who underwent immediate surgery for subdural hematomas, with no differences noted in outcomes on multivariate analysis.
This study suggests that operating AH does not appear to negatively impact outcomes when compared with operating DH, in cases of cranial neurosurgical emergencies. Further study assessing the impact on elective neurosurgical cases is required.
夜间及周末进行的手术被认为与并发症增加有关。然而，一天中的时间对颅脑神经外科手术结果的影响尚未得到研究。我们旨在确定与正常工作时间（DH）进行的颅脑神经外科手术相比，非工作时间（AH）进行的手术在结果上是否存在差异。
我们对2015年1月至2019年12月期间接受急诊手术的颅脑神经外科患者进行了单中心回顾性研究。如果手术切口发生在周一至周五上午8点至下午5点之间，则认为是正常工作时间手术。我们评估了正常工作时间或非工作时间进行的手术之间结果指标的差异。
393例患者（114例正常工作时间手术，279例非工作时间手术）接受了手术。多因素分析显示，非工作时间手术患者30天内返回手术室的比例（8.6%）低于正常工作时间手术患者（14.0%），P = 0.03。正常工作时间手术与非工作时间手术相比，手术时长、估计失血量、格拉斯哥昏迷量表改善情况、重症监护病房住院时长和总住院时长、30天再入院率、30天死亡率和院内死亡率均无显著差异。对因硬膜下血肿立即进行手术的患者进行了进一步亚组分析，多因素分析结果显示结果无差异。
本研究表明，在颅脑神经外科急诊病例中，与正常工作时间手术相比，非工作时间手术似乎不会对结果产生负面影响。需要进一步研究评估对择期神经外科病例的影响。
