Afternoon Surgical Start Time Is Associated with Higher Cost and Longer Length of Stay in Posterior Lumbar Fusion

Neifert, Sean N; Martini, Michael L; Gal, Jonathan S.; Maron, Samuel Z.; Rasouli, Jonathan; Lamb, Colin D.; Rothrock, Robert J.; McNeill, Ian T; Grant, Lauren K.; Genadry, Lisa; Cho, Samuel K.; Caridi, John M.

doi:10.1016/j.wneu.2020.07.082

Cited by 9 publications

(6 citation statements)

References 41 publications

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“…Unlike other previous studies, our results did not support the idea that the later surgical start time (later cohort) itself might associated with longer LOS or higher cost ( 8 , 20 ). Specifically, our results showed similar total cost, total LOS or post-op LOS inside the same group regardless of surgical start time.…”

Section: Discussioncontrasting

confidence: 99%

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Real-World Implementation of Neurosurgical Enhanced Recovery After Surgery Protocol for Gliomas in Patients Undergoing Elective Craniotomy

et al. 2022

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ObjectiveTo design a multidisciplinary enhanced recovery after surgery (ERAS) protocol for glioma patients undergoing elective craniotomy and evaluate its clinical efficacy and safety after implementation in a tertiary neurosurgical center in China.MethodsERAS protocol for glioma patients was developed and modified based on the best available evidence. Patients undergoing elective craniotomy for treatment of glioma between September 2019 to May 2021 were enrolled in a randomized clinical trial comparing a conventional neurosurgical perioperative care (control group) to an ERAS protocol (ERAS group). The primary outcome was postoperative hospital length of stay (LOS). Secondary outcomes were 30-day readmission rate, postoperative complications, duration of the drainage tube, time to first oral fluid intake, time to ambulation and functional recovery status.ResultsA total of 151 patients were enrolled (ERAS group: n = 80; control group: n = 71). Compared with the control group, postoperative LOS was significantly shorter in the ERAS group (median: 5 days vs. 7 days, p<0.0001). No 30-day readmission or reoperation occurred in either group. The time of first oral intake, urinary catheter removal within 24 h and early ambulation on postoperative day (POD) 1 were earlier and shorter in the ERAS group compared with the control group (p<0.001). No statistical difference was observed between the two groups in terms of surgical- and nonsurgical-related complications. Functional recovery in terms of Karnofsky Performance Status (KPS) scores both at discharge and 30-day follow-up was similar in the two groups. Moreover, no significant difference was found between the two groups in the Hospital Anxiety and Depression Scale (HADS) scores.ConclusionThe implementation of the ERAS protocol for glioma patients offers significant benefits over conventional neurosurgical perioperative management, as it is associated with enhancing postoperative recovery, without additional perioperative complications and risks.Clinical Trial RegistrationChinese Clinical Trial Registry (http://www.chictr.org.cn/showproj.aspx?proj=42016), identifier ChiCTR1900025108

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Section: Discussioncontrasting

confidence: 99%

“…Similar to the article by Sean et al. ( 8 ), we set the cut-off point as 2 PM. The demarcation of the 2 PM start time was not arbitrary, but based on the inherent shift changes that impact operating room staff, including nursing, surgical technologists, and anesthetists.…”

Section: Resultsmentioning

confidence: 99%

Real-World Implementation of Neurosurgical Enhanced Recovery After Surgery Protocol for Gliomas in Patients Undergoing Elective Craniotomy

et al. 2022

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“…Patients having a major spine surgery in the afternoon are expected to prefer spending the night in the hospital than to be discharged late in the evening. Previous studies had also shown that late surgical start time (after 2 pm ) was associated with longer LOS and higher costs 25,26. Thus, scheduling the surgery for the earlier part of the day and reallocation of PT resources seem to be the foremost interventions that can increase the likelihood of same-day discharge.…”

Section: Discussionmentioning

confidence: 97%

“…Previous studies had also shown that late surgical start time (after 2 PM) was associated with longer LOS and higher costs. 25,26 Thus, scheduling the surgery for the earlier part of the day and reallocation of PT resources seem to be the foremost interventions that can increase the likelihood of same-day discharge.…”

Section: Discussionmentioning

confidence: 99%

Factors Causing Delay in Discharge in Patients Eligible for Ambulatory Lumbar Fusion Surgery

Shahi

Vaishnav

Melissaridou

et al. 2022

Spine

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Study Design. Retrospective review of prospectively collected data. Objective. To analyze the postoperative factors that led delayed discharge in patients who would have been eligible for ambulatory lumbar fusion (ALF). Summary of Background Data. Assessing postoperative inefficiencies is vital to increase the feasibility of ALF. Materials and Methods. Patients who underwent single-level minimally invasive transforaminal lumbar interbody fusion and would have met the eligibility criteria for ALF were included. Length of stay (LOS); time in postanesthesia recovery unit (PACU); alertness and neurological examination, and pain scores at three and six hours; type of analgesia; time to physical therapy (PT) visit; reasons for PT nonclearance; time to per-oral (PO) intake; time to voiding; time to readiness for discharge were assessed. Time taken to meet each discharge criterion was calculated. Multiple regression analyses were performed to study the effect of variables on postoperative parameters influencing discharge. Results. Of 71 patients, 4% were discharged on the same day and 69% on postoperative day 1. PT clearance was the last-met discharge criterion in 93%. Sixty-six percent did not get PT evaluation on the day of surgery. Seventy-six percent required intravenous opioids and <60% had adequate pain control. Twenty-six percent had orthostatic intolerance. The median postoperative LOS was 26.9 hours, time in PACU was 4.2 hours, time to PO intake was 6.5 hours, time to first void was 6.3 hours, time to first PT visit was 17.7 hours, time to PT clearance was 21.8 hours, and time to discharge readiness was 21.9 hours. Regression analysis showed that time to PT clearance, time to PO intake, time to voiding, time in PACU, and pain score at three hours had a significant effect on LOS. Conclusions. Unavailability of PT, surgery after 1 pm, orthostatic intolerance, inadequate pain control, prolonged PACU stay, and long feeding and voiding times were identified as modifiable factors preventing same-day discharge. Level of Evidence. 4.

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“…In the orthopedic spine literature, studies have shown that afternoon anterior cervical discectomy and fusions (ACDFs) and posterior lumbar fusions (PFLs) have increased LOS when compared to morning start cases (Mayo et al 2016;Neifert et al 2020). After-hours orthopedic trauma cases have also been shown to have higher mortality and complication rates (Halvachizadeh et al 2019).…”

Section: Introductionmentioning

confidence: 99%

Total Joint Arthroplasty Time-of-Day Start Time Has Minimal Effect on Intraoperative Efficiency

Hammoor,

Kaidi,

Hickernell

et al. 2023

Journal of Orthopaedic Experience &Amp; Innovation

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Introduction Total hip (THA) and knee arthroplasties (TKA) are common elective procedures, and dedicated arthroplasty teams perform multiple procedures per day. Little is documented about how time-of-day scheduling affects the intraoperative efficiency of total joint arthroplasties (TJA). In this study, we analyzed the effects of surgical start time on TJA operative lengths. Methods A retrospective study was performed for primary TJA patients done within a four-year period at a single academic medical center. Surgical start time, operative duration, and patient demographics were collected. Based on a 12-hour operative day, surgical start times were categorized as early (7AM to 11AM), mid-day (11AM to 3PM), or late (after 3PM). A chi-squared test was performed to examine for associations between patient demographics and surgical start time. A multivariate linear regression (MLR) was performed to determine the effect of surgical start time on operative duration. P-values less than 0.05 were considered significant. Results This study identified 1663 TJAs – 869 total knee (TKA) and 791 total hip arthroplasties (THA) who met inclusion criteria. Among TKAs, we identified 319 (36.7%) early, 437 (50.3%) mid-day, and 113 (13.0%) late operations. Among THAs, we identified 407 (51.4%) early, 297 (37.5%) mid-day, and 87 (11.0%) late operations. MLR demonstrated that for TKA there was a 4.9 (p =0.018) and 7.3 (p=0.013) minute increase for mid-day and late cases, respectively. For THAs, a non-early start time was associated with an increased operative duration of 9.1 to 12 minutes (p<0.001). Discussion Surgical start time has a statistically significant, but minimal, effect on operative length for TJAs, with later cases being slightly longer than first-start cases.

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Afternoon Surgical Start Time Is Associated with Higher Cost and Longer Length of Stay in Posterior Lumbar Fusion

Cited by 9 publications

References 41 publications

Real-World Implementation of Neurosurgical Enhanced Recovery After Surgery Protocol for Gliomas in Patients Undergoing Elective Craniotomy

Real-World Implementation of Neurosurgical Enhanced Recovery After Surgery Protocol for Gliomas in Patients Undergoing Elective Craniotomy

Factors Causing Delay in Discharge in Patients Eligible for Ambulatory Lumbar Fusion Surgery

Total Joint Arthroplasty Time-of-Day Start Time Has Minimal Effect on Intraoperative Efficiency

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