Comparing Outcomes for Emergent Cranial Neurosurgical Procedures Performed “During Hours” and “After Hours”

Abstract

ObjectiveSurgery 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 to during hours (DH). MethodsWe 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 0800 and 1700 Monday through Friday. We assessed outcome measures for differences between operations performed DH or AH. Results393 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 to DH (14.0%), p = 0.03, on multivariate analysis. There were no significant differences in length of operation, estimated blood loss (EBL), improvement in Glasgow Coma Scale (GCS), Intensive Care Unit (ICU) and total hospital length of stay (LOS), 30-day readmission, 30-day mortality, and in-hospital mortality for cases performed DH compared to AH. Further subgroup analyses were performed for patients who underwent immediate surgery for subdural hematomas, with no differences noted in outcomes on multivariate analysis. ConclusionsThis study suggests that operating AH does not appear to negatively impact outcomes when compared to operating DH, in cases of cranial neurosurgical emergencies. Further study assessing the impact on elective neurosurgical cases is required.