72. Operation timing affects outcomes after adult spinal deformity surgery

Abstract

BACKGROUND CONTEXT Adult spinal deformity (ASD) surgery can entail complex reconstructive procedures in patients with multiple comorbidities. Postoperative complications can range from minor complications such as ileus, to significant neurologic injury. ASD surgery is commonly scheduled for weekdays, with first start times. It is unclear if there is any effect of time-related performance impairment on the surgical team. PURPOSE To investigate the rate of complications based on day of the week, or time of day, that ASD surgeries are performed. STUDY DESIGN/SETTING Retrospective review of prospectively collected single center database. PATIENT SAMPLE 1040 ASD patients (Age: 46 ± 23; BMI 25 ± 7, ASA 2.5 ± 0.6, Levels fused 10 ± 4, Revision procedure: 9%, 3CO: 13%) were included in the analysis. OUTCOME MEASURES Overall complication rate, and 90-day readmission and reoperation rates. METHODS We collected start times and day of the week for ASD cases occurring at our institution from 2011-2018. First start was designated as any case starting at 7:30 AM; late start was designated as any case starting 11 am and after. Day of week was modelled as a categorical variable, with Monday as the reference group. RESULTS 1040 ASD patients (Age: 46 ± 23; BMI 25 ± 7, ASA 2.5 ± 0.6, Levels fused 10 ± 4, Revision procedure: 9%, 3CO: 13%) were included. After controlling for patient and case characteristics, there was no association between day of week and length of stay, or 90-day complication, readmission, or reoperation rates in the adjusted analyses. Late start cases (n=269) had higher rates of 90-day readmission (10.4% vs 6.0%, p=0.02), reoperation (11.9% vs 6.6%, p=0.008), and neurologic injury (5.2% vs 2.3%, 0.019). Sub-analysis of types of neurologic complications encountered demonstrated that in late start cases, there was a higher rate of postoperative radiculopathy (3.3% vs 0.9%, p=0.007), and residual central or foraminal stenosis (2.2% vs 0.6%, p=0.029). Late start cases were predictive of increased risk for 90-day readmission (OR 1.8, CI: 1.1-3.0, p=0.02), unplanned reoperation (OR 1.9, CI:1.2-3.1, p=0.009), and neurologic complication (OR 2.1, CI: 1.0-4.3, p=0.046). CONCLUSIONS Risk of morbidity after elective ASD surgery is not associated with day of the week, in an analysis of over 1000 cases. A late OR start time was predictive of increased risk for neurologic complication, and 90-day readmission and unplanned reoperation. Well-established protocols for first start OR times for elective ASD surgery may decrease outcome risk and reduce variability in complication rates. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.