The Effect of Surgical Start Time on Complications Associated With Neurological Surgeries

Linzey, Joseph R; Burke, James F.; Sabbagh, Maya; Sullivan, Stephen E.; Thompson, B. Gregory; Muraszko, Karin M.; Pandey, Aditya S.

doi:10.1093/neuros/nyx485

Cited by 30 publications

(18 citation statements)

References 20 publications

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“…Such studies have found no relationship between afterhours surgery and complications for pediatric appendectomy 6 or adult neurosurgery. 7 Few data are available concerning surgical outcomes and complications related to the time of day for scheduled elective surgical procedures. One study identified an elevated risk of morbidity for nonemergent procedures starting between 4 p.m. and 6 p.m. and a further elevated risk for morbidity in cases starting after 6 p.m. 8 Although generally considered a rather safe procedure, outpatient pediatric tonsillectomy carries with it a 14-day readmission rate of approximately 7.6% with revisits attributable to postoperative hemorrhage, acute pain and fever/vomiting/ dehydration.…”

Section: Discussionmentioning

confidence: 99%

Revisit Rates for Pediatric Tonsillectomy: An Analysis of Admit and Discharge Times

Gilani

Bhattacharyya

2019

Ann Otol Rhinol Laryngol

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Objective: To determine the association between intraday timing of outpatient pediatric tonsillectomy and revisit outcomes and complications. Study Design: Cross-sectional analysis of New York databases. Setting: Ambulatory surgery, emergency department and inpatient hospital settings. Subjects and Methods: The State Ambulatory Surgery, State Emergency Department and State Inpatient Databases for 2010-2011 were analyzed for revisits. Outcomes assessed were revisits for any reason, bleeding, acute pain or fever, nausea, vomiting and dehydration. The relationships between the hour of admission for surgery, the hour of discharge and the revisit outcomes were analyzed. Results: The study included 33,611 children (mean age, 6.62 years; 45.7% female) and 62.0% were admitted in the early morning. Discharges were most common in the early afternoon (28.3%). Revisit rates were significantly higher for the early evening discharges (6.0%) versus late morning discharges (3.1%) ( P < .001). Revisits for bleeding were 1.8% for discharge in the early evening versus 0.6% in the late morning ( P < .001). Revisits for fever, nausea, vomiting or dehydration were 1.8% for discharge in the early evening versus 0.9% in the late morning ( P = .002). Late afternoon admission was significantly associated with higher revisit rates (10.9%, P < .001). Bleeding revisits were highest for late afternoon admit hour (1.5%, P = .001). Revisits for acute pain were also highest for late afternoon admit hour (2.3%, P = .005). Conclusion: Revisit are significantly higher when the patient is discharged late. Late afternoon surgery is also significantly associated with higher revisit rates. Surgeons may wish to consider these findings when a late tonsillectomy or late discharge is anticipated post-tonsillectomy.

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Section: Discussionmentioning

confidence: 99%

Revisit Rates for Pediatric Tonsillectomy: An Analysis of Admit and Discharge Times

Gilani

Bhattacharyya

2019

Ann Otol Rhinol Laryngol

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“…Other specialties have studied the effect of surgical start time on postoperative morbidity and mortality and have demonstrated a later start time as an independent risk factor for poor outcomes. 5,6,19 Yet, this finding is not consistent across all specialties and institutions with some studies finding no difference. 20–22…”

Section: Discussionmentioning

confidence: 72%

“…morning chronotypes in the evening) which has potential implications for surgical success and complications. 4 Linzey et al 5 reported an increased risk of morbidity following neurosurgery when the case started between 21:01 and 07:00, while Kork et al 6 demonstrated an increased risk of postoperative mortality in all surgical cases starting between 13:00 and 17:00 compared to 08:00 to 11:00. It is more difficult to show a difference in ocular surgery as most cases are elective and scheduled during regular hours.…”

Section: Introductionmentioning

confidence: 99%

Surgical timing and presence of a vitreoretinal fellow on postoperative adverse events following pars plana vitrectomy

Shields

Ludwig

Powers

et al. 2018

European Journal of Ophthalmology

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Introduction: To evaluate the adverse event rate following pars plana vitrectomy as a function of surgical start time and the presence of a vitreoretinal fellow. Methods: Single-institution retrospective cohort study of patients undergoing pars plana vitrectomy from 1 January 2016 to 31 December 2016 at Stanford University School of Medicine (Palo Alto, CA, USA). Records were reviewed for surgical start time, the presence of vitreoretinal fellow, and postoperative adverse events defined as any finding deviating from the expected postoperative course requiring observation or intervention. Results: A total of 310 pars plana vitrectomies were performed. There was no statistical difference in the rate of any adverse event when comparing cases starting after 16:01 (9/13, 69.2%) and after 12:01 (42/99, 42.4%) to a morning start time (69/198, 34.9%, adjusted p = 0.083). There was a statistically significant increase in the risk of postoperative vitreous hemorrhage with afternoon and evening cases as compared to morning cases (adjusted p = 0.021). In addition, there was no difference in any adverse event with a fellow present (93/244, 38.1%) compared to without (27/66, 40.9%, adjusted p = 0.163). There was a higher risk of postoperative hypotony when a fellow was involved (6.6% vs 0%, p = 0.028), though this difference disappeared after adjusting for confounders (adjusted p = 0.252). There was no difference in the length of surgery with and without a fellow (49 vs 54 min, respectively; p = 0.990). Discussion: Afternoon start time and the presence of a fellow were not independent risk factors for postoperative adverse events.

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“…We have previously reported an increased incidence of surgical com- plications following operations with a late SST. 15 These differences could reflect surgeon fatigue, the more chaotic nature of a night encounter, or the desire for heroic operations that may have been declined during the day. It could also represent the fact that, at our institution, the neurosurgical resident serves as the primary person offering surgery during "off hours," whereas the entire team, including neurosurgical attending personnel, is available for discussion with the family during "on-hour" presentations.…”

Section: Discussionmentioning

confidence: 99%

Incidence of the initiation of comfort care immediately following emergent neurosurgical and endovascular procedures

Linzey

Burke²,

Nadel

et al. 2019

Journal of Neurosurgery

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OBJECTIVEIt is unknown what proportion of patients who undergo emergent neurosurgical procedures initiate comfort care (CC) measures shortly after the operation. The purpose of the present study was to analyze the proportion and predictive factors of patients who initiated CC measures within the same hospital admission after undergoing emergent neurosurgery.METHODSThis retrospective cohort study included all adult patients who underwent emergent neurosurgical and endovascular procedures at a single center between 2009 and 2014. Primary and secondary outcomes were initiation of CC measures during the initial hospitalization and determination of predictive factors, respectively.RESULTSOf the 1295 operations, comfort care was initiated in 111 (8.6%) during the initial admission. On average, CC was initiated 9.3 ± 10.0 days postoperatively. One-third of the patients switched to CC within 3 days. In multivariate analysis, patients > 70 years of age were significantly more likely to undergo CC than those < 50 years (70–79 years, p = 0.004; > 80 years, p = 0.0001). Two-thirds of CC patients had been admitted with a cerebrovascular pathology (p < 0.001). Admission diagnosis of cerebrovascular pathology was a significant predictor of initiating CC (p < 0.0001). A high Hunt and Hess grade of IV or V in patients with subarachnoid hemorrhage was significantly associated with initiation of CC compared to a low grade (27.1% vs 2.9%, p < 0.001). Surgery starting between 15:01 and 06:59 hours had a 1.70 times greater odds of initiating CC compared to surgery between 07:00 and 15:00.CONCLUSIONSInitiation of CC after emergent neurosurgical and endovascular procedures is relatively common, particularly when an elderly patient presents with a cerebrovascular pathology after typical operating hours.

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The Effect of Surgical Start Time on Complications Associated With Neurological Surgeries

Abstract: 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.

Cited by 30 publications

References 20 publications

Revisit Rates for Pediatric Tonsillectomy: An Analysis of Admit and Discharge Times

Revisit Rates for Pediatric Tonsillectomy: An Analysis of Admit and Discharge Times

Surgical timing and presence of a vitreoretinal fellow on postoperative adverse events following pars plana vitrectomy

Incidence of the initiation of comfort care immediately following emergent neurosurgical and endovascular procedures

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