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Tanaka T, Sasaki M, Katayanagi J, Hirakawa A, Fushimi K, Yoshii T, Jinno T, Inose H. Trends, costs, and complications associated with after-hours surgery and unscheduled hospitalization in spinal surgery. Bone Jt Open 2024; 5:662-670. [PMID: 39117344 PMCID: PMC11309809 DOI: 10.1302/2633-1462.58.bjo-2024-0026.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/10/2024] Open
Abstract
Aims The escalating demand for medical resources to address spinal diseases as society ages is an issue that requires careful evaluation. However, few studies have examined trends in spinal surgery, especially unscheduled hospitalizations or surgeries performed after hours, through large databases. Our study aimed to determine national trends in the number of spine surgeries in Japan. We also aimed to identify trends in after-hours surgeries and unscheduled hospitalizations and their impact on complications and costs. Methods We retrospectively investigated data extracted from the Diagnosis Procedure Combination database, a representative inpatient database in Japan. The data from April 2010 to March 2020 were used for this study. We included all patients who had undergone any combination of laminectomy, laminoplasty, discectomy, and/or spinal arthrodesis. Results This investigation included 739,474 spinal surgeries and 739,215 hospitalizations in Japan. There was an average annual increase of 4.6% in the number of spinal surgeries. Scheduled hospitalizations increased by 3.7% per year while unscheduled hospitalizations increased by 11.8% per year. In-hours surgeries increased by 4.5% per year while after-hours surgeries increased by 9.9% per year. Complication rates and costs increased for both after-hours surgery and unscheduled hospitalizations, in comparison to their respective counterparts of in-hours surgery and scheduled hospitalizations. Conclusion This study provides important insights for those interested in improving spine care in an ageing society. The swift surge in after-hours spinal surgeries and unscheduled hospitalizations highlights that the medical needs of an increasing number of patients due to an ageing society are outpacing the capacity of existing medical resources.
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Affiliation(s)
- Tomoyuki Tanaka
- Department of Orthopaedic Surgery, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Masanao Sasaki
- Department of Biostatistics, M&D Data Science Center, Tokyo Medical and Dental University, Tokyo, Japan
| | - Junya Katayanagi
- Department of Orthopaedic Surgery, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Akihiko Hirakawa
- Department of Biostatistics, M&D Data Science Center, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Toshitaka Yoshii
- Department of Orthopedics, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tetsuya Jinno
- Department of Orthopaedic Surgery, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Hiroyuki Inose
- Department of Orthopaedic Surgery, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
- Department of Orthopedics, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan
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Dandurand C, Laghaei PF, Fisher CG, Ailon T, Dvorak M, Kwon BK, Dea N, Charest-Morin R, Paquette S, Street JT. Out-of-hours emergent surgery for degenerative spinal disease in Canada: a retrospective cohort study from a national registry. LANCET REGIONAL HEALTH. AMERICAS 2024; 36:100816. [PMID: 38966387 PMCID: PMC11223085 DOI: 10.1016/j.lana.2024.100816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 05/28/2024] [Accepted: 05/29/2024] [Indexed: 07/06/2024]
Abstract
Background Spinal degenerative disease represents a growing burden on our healthcare system, yet little is known about longitudinal trends in access and care. Our goal was to provide an essential portrait of surgical volume trends for degenerative spinal pathologies within Canada. Methods The Canadian Institute for Health Information (CIHI) database was used to identify all patients receiving surgery for a degenerative spinal condition from 2006 to 2019. Trends in number of interventions, unscheduled vs scheduled hospitalizations, in-hours vs out-of-hours interventions, resource utilization and adverse events were analyzed retrospectively using linear regression models. Confidence intervals were reported in the expected count ratio scale (CR). Findings A total of 338,629 spinal interventions and 256,360 hospitalizations between 2006 and 2019 were analyzed. The mean and SD of the annual mean age of patients was 55.5 (SD 1.6) for elective hospitalizations and 55.6 (SD 1.6) for emergent hospitalizations. The proportion of female patients was 47.8% (91,789/192,027) for elective hospitalizations and 41.4% (26,633/64,333) for emergent hospitalizations. Elective hospitalizations increased an average of 2.0% per year, with CR = 1.020 (95% CI 1.017-1.023, p < 0.0001) while emergent hospitalizations exhibited more rapid growth with an average 3.4% annually, with CR 1.034 (95% CI 1.027-1.040, p < 0.0001). «In-hours » surgeries increased on average 2.7% per year, with CR 1.027 (95% CI 1.021-1.033, p < 0.0001), while « out-of-hours » surgeries increased 6.1% annually, with CR 1.061 (95% CI 1.051-1.071, p < 0.0001). The resource utilization for unscheduled hospitalizations approximates two and a half times that of scheduled hospitalizations. The proportions of spinal interventions with at least one adverse event increased on average 6.3% per year, with CR 1.063 (95% CI 1.049-1.077, p < 0.0001). Interpretation This study provides novel data critical for all providers and stakeholders. The rapid growth of emergent out-of-hours hospitalizations demonstrates that the needs of this growing patient population have far exceeded health-care resource allocations. Future studies will analyze the health-related quality of life implications of this system shift and identify demographic and socioeconomic inequities in access to surgical care. Funding This work was funded by the Bob and Trish Saunders Spine Research Fund through The VGH and UBC Hospital Foundation. The funder of the study had no role in the study design, data collection, data analysis, data interpretation, or writing of the manuscript.
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Affiliation(s)
- Charlotte Dandurand
- Combined Neurosurgical and Orthopedic Spine Program, University of British Columbia, Vancouver, Canada
| | - Pedram Farimani Laghaei
- Combined Neurosurgical and Orthopedic Spine Program, University of British Columbia, Vancouver, Canada
| | - Charles G. Fisher
- Combined Neurosurgical and Orthopedic Spine Program, University of British Columbia, Vancouver, Canada
| | - Tamir Ailon
- Combined Neurosurgical and Orthopedic Spine Program, University of British Columbia, Vancouver, Canada
| | - Marcel Dvorak
- Combined Neurosurgical and Orthopedic Spine Program, University of British Columbia, Vancouver, Canada
| | - Brian K. Kwon
- Combined Neurosurgical and Orthopedic Spine Program, University of British Columbia, Vancouver, Canada
| | - Nicolas Dea
- Combined Neurosurgical and Orthopedic Spine Program, University of British Columbia, Vancouver, Canada
| | - Raphaële Charest-Morin
- Combined Neurosurgical and Orthopedic Spine Program, University of British Columbia, Vancouver, Canada
| | - Scott Paquette
- Combined Neurosurgical and Orthopedic Spine Program, University of British Columbia, Vancouver, Canada
| | - John T. Street
- Combined Neurosurgical and Orthopedic Spine Program, University of British Columbia, Vancouver, Canada
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Kanda Y, Kakutani K, Sakai Y, Yurube T, Takeoka Y, Miyazaki K, Ohnishi H, Matsuo T, Ryu M, Kumagai N, Kuroshima K, Hiranaka Y, Kuroda R. Clinical Characteristics, Surgical Outcomes, and Risk Factors for Emergency Surgery in Patients With Spinal Metastases: A Prospective Cohort Study. Neurospine 2024; 21:314-327. [PMID: 38317551 PMCID: PMC10992628 DOI: 10.14245/ns.2347012.506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 12/19/2023] [Accepted: 01/05/2024] [Indexed: 02/07/2024] Open
Abstract
OBJECTIVE To elucidate the patient characteristics and outcomes of emergency surgery for spinal metastases and identify risk factors for emergency surgery. METHODS We prospectively analyzed 216 patients with spinal metastases who underwent palliative surgery from 2015 to 2020. The Eastern Cooperative Oncology Group performance status, Barthel index, EuroQol-5 dimension (EQ5D), and neurological function were assessed at surgery and at 1, 3, and 6 months postoperatively. Multivariate analysis was performed to identify risk factors for emergency surgery. RESULTS In total, 146 patients underwent nonemergency surgery and 70 patients underwent emergency surgery within 48 hours of diagnosis of a surgical indication. After propensity score matching, we compared 61 patients each who underwent nonemergency and emergency surgery. Regardless of matching, the median performance status and the mean Barthel index and EQ5D score showed a tendency toward worse outcomes in the emergency than nonemergency group both preoperatively and 1 month postoperatively, although the surgery greatly improved these values in both groups. The median survival time tended to be shorter in the emergency than nonemergency group. The multivariate analysis showed that lesions located at T3-10 (p = 0.002; odds ratio [OR], 2.92; 95% confidence interval [CI], 1.48-5.75) and Frankel grades A-C (p < 0.001; OR, 4.91; 95% CI, 2.45-9.86) were independent risk factors for emergency surgery. CONCLUSION Among patients with spinal metastases, preoperative and postoperative subjective health values and postoperative survival are poorer in emergency than nonemergency surgery. Close attention to patients with T3-10 metastases is required to avoid poor outcomes after emergency surgery.
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Affiliation(s)
- Yutaro Kanda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kenichiro Kakutani
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yoshitada Sakai
- Division of Rehabilitation Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takashi Yurube
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yoshiki Takeoka
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kunihiko Miyazaki
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hiroki Ohnishi
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tomoya Matsuo
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masao Ryu
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Naotoshi Kumagai
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kohei Kuroshima
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yoshiaki Hiranaka
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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Debono B, Perez A, Lonjon G, Hamel O, Dandine JB, Dupuy M, Dutertre G, Braticevic C, Latorzeff I, Amelot A. Enhancing the referral process for surgical management of spinal metastases: insights from a 12-year, bi-institutional study of 533 patients. Front Oncol 2024; 14:1301305. [PMID: 38352892 PMCID: PMC10861661 DOI: 10.3389/fonc.2024.1301305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 01/16/2024] [Indexed: 02/16/2024] Open
Abstract
Introduction Delayed surgical management of spinal metastases (SMs) can have detrimental effects on patient survival and quality of life, leading to pain and potential neurological impairment. This study aimed to assess the impact of delayed referral for SMs on clinical outcomes by analyzing patients managed in emergency situations. Methods We retrospectively reviewed the data of all patients admitted on either emergency or elective basis who underwent surgery for the treatment of neoplastic spine lesions at our two institutions (tertiary referral neurosurgical units) between January 2008 and December 2019. Results We analyzed 210 elective (EGp) and 323 emergency patients (UGp); emergencies increased significantly over the 12-year period, with a Friday peak (39.3%) and frequent neurological impairment (61.6% vs. 20%). Among the UGp patients, 186 (7.5%) had a previously monitored primitive cancer, including 102 (31.6%) with known SMs. On admission, 71 of the 102 (69.9%) patients presented with neurological deficits. UGp patients were more likely to undergo a single decompression without fixation. Outcomes at the 3-month follow-up were significantly worse for UGp patients ([very] poor, 29.2 vs. 13.8%), and the median overall survival for UGp patients was statistically lower. Risk factors for patients with SM undergoing emergency management included short delay between onset of symptoms and first contact with a spine surgeon, and an initial motor deficit. Conclusion Many patients with previously identified metastases, including those with neurological deficits, are urgently referred. Optimization is needed in the oncology pathway, and all stakeholders must be made aware of the factors contributing to the improvement in the clinical and radiological identification of potential complications affecting patient survival and quality of life.
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Affiliation(s)
- Bertrand Debono
- Department of Neurosurgery, Paris-Versailles Spine Center, Hôpital privé de Versailles, Versailles, France
| | - Alexis Perez
- Department of Neurosurgery, Clinique de l’Union, Toulouse, France
| | - Guillaume Lonjon
- Department of Orthopedic Surgery, Orthosud, Clinique St-Jean-Sud de France, Santé Cite Group, Montpellier Metropole, France
| | - Olivier Hamel
- Department of Neurosurgery, Clinique des Cédres, Toulouse, France
| | | | - Martin Dupuy
- Department of Neurosurgery, Clinique de l’Union, Toulouse, France
| | - Guillaume Dutertre
- Institut Curie, Paris Sciences et Lettres (PSL) Research University, Surgical Oncology Department, Paris, France
| | - Cécile Braticevic
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Igor Latorzeff
- Department of Radiotherapy, Groupe ONCORAD Garonne, Clinique Pasteur, Toulouse, France
| | - Aymeric Amelot
- Department of Neurosurgery, Hopital Bretonneau, Tours, France
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Vergouwen M, Tarcea A, Van Essen D, Sayre EC, White NJ. FROST 2.0: Factors Predicting Orthopaedic Trauma Volumes - A Validation Study. Injury 2023; 54:111111. [PMID: 37839917 DOI: 10.1016/j.injury.2023.111111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 10/03/2023] [Accepted: 10/07/2023] [Indexed: 10/17/2023]
Abstract
The anecdotal relationship between weather, season, and orthopaedic trauma volumes is understood by patients and healthcare providers: when the winter ground is icy, people fall. Previous research established that winter and summer months as well as ice and snow were significant predictors of orthopaedic trauma and surges in volumes. The current study validates the previously established predictive model in one Canadian city; the original methods were repeated using a new, yet geographically similar dataset. The effect of month and ice were consistent, which suggests the proposed model has sufficient external validity to guide resource allocation and primary prevention strategies.
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Affiliation(s)
- Martina Vergouwen
- Cumming School of Medicine, University of Calgary, 2500 University Drive, NW T2N 1N4 Calgary, AB Canada.
| | - Adina Tarcea
- Section of Orthopaedics, Cumming School of Medicine, University of Calgary, 2500 University Drive, NW T2N 1N4 Calgary, AB Canada
| | - Darren Van Essen
- Cumming School of Medicine, University of Calgary, 2500 University Drive, NW T2N 1N4 Calgary, AB Canada
| | - Eric C Sayre
- Arthritis Research Canada, 5591 Number 3 Rd, V6X 2C7 Richmond, BC Canada
| | - Neil J White
- Section of Orthopaedics, Cumming School of Medicine, University of Calgary, 2500 University Drive, NW T2N 1N4 Calgary, AB Canada
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Cave DGW, Lillitos PJ, Lancaster R, Bentham JR, Barwick S. Out-of-hours versus in-hours delivery of antenatally diagnosed transposition of the great arteries: outcomes from a United Kingdom Tertiary Centre. Cardiol Young 2023; 33:1873-1878. [PMID: 36325964 DOI: 10.1017/s1047951122003250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To study the impact of out-of-hours delivery on outcome for neonates with antenatally diagnosed transposition of the great arteries. SETTING Tertiary paediatric cardiology centre (Yorkshire, United Kingdom), with co-located tertiary neonatal unit. PATIENTS Neonates with antenatally diagnosed simple transposition of the great arteries delivered out-of-hours (Monday to Friday 17:00-08:00 and weekends) versus in-hours between 2015 and 2020. OUTCOME The primary outcome was survival to hospital discharge. Secondary outcomes included neurological morbidity, length of stay, and time to balloon atrial septostomy. RESULTS Of 51 neonates, 38 (75%) were delivered out-of-hours. All neonates born in the tertiary centre survived to discharge. Time to balloon atrial septostomy was slightly longer for out-of-hours deliveries compared to in-hours (median 130 versus 93 mins, p = 0.33). Neurological morbidity occurred for nine (24%) patients in the out-of-hours group and one (8%) in-hours (OR 3.72, 95% CI: 0.42-32.71, p = 0.24). Length of stay was also similar (18.5 versus 17.3 days, p = 0.59). Antenatal diagnosis of a restrictive atrial septum was associated with a lower initial pH (7.03 versus 7.13; CI: 0.03-0.17, p = 0.01), longer length of stay (22.6 versus 17.3 days; CI: 0.37-10.17, p = 0.04), and increased neurological morbidity (44% versus 14%; OR 4.80, CI 1.00-23.15, p = 0.05). A further three neonates were delivered in surrounding hospitals, with a mortality of 67% (versus 0 in tertiary centre; OR 172, CI 5-5371, p = 0.003). CONCLUSION Neonates with antenatally diagnosed transposition of the great arteries have similar outcomes when delivered out-of-hours versus in-hours. Antenatal diagnosis of restrictive atrial septum is a significant predictor of worse outcomes. In our region, delivery outside the tertiary cardiac centre had a significantly higher risk of mortality.
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Affiliation(s)
- Daniel G W Cave
- Leeds Congenital Heart Unit, Leeds Children's Hospital, Great George Street, Leeds, West Yorkshire, UK
- University of Leeds, Leeds, West Yorkshire, UK
| | - Peter J Lillitos
- Leeds Congenital Heart Unit, Leeds Children's Hospital, Great George Street, Leeds, West Yorkshire, UK
| | - Rebecca Lancaster
- Leeds Congenital Heart Unit, Leeds Children's Hospital, Great George Street, Leeds, West Yorkshire, UK
| | - James R Bentham
- Leeds Congenital Heart Unit, Leeds Children's Hospital, Great George Street, Leeds, West Yorkshire, UK
| | - Shuba Barwick
- Leeds Congenital Heart Unit, Leeds Children's Hospital, Great George Street, Leeds, West Yorkshire, UK
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Persad AR, Mercure-Cyr R, Spiess M, Woo A, Tymchak Z, Wu A, Hnenny L, Fourney DR. Encrypted smartphone text messaging between spine surgeons may reduce after-hours surgery. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:3330-3336. [PMID: 36264347 DOI: 10.1007/s00586-022-07423-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 09/07/2022] [Accepted: 10/10/2022] [Indexed: 11/07/2022]
Abstract
PURPOSE "After-hours" non-elective spine surgery is associated with increased morbidity. Decision-making may be enhanced by collaborative input from experienced local colleagues. At our center, we implemented routine use of a cross-platform messaging system (CPMS; WhatsApp Inc., Mountain View, California) to facilitate quality care discussions and collaborative surgical decision-making between spine surgeons prior to booking cases with the operating room. Our aim is to determine whether encrypted text messaging for shared decision-making between spine surgeons affects the number or type of after-hours spine procedures. METHODS We retrospectively compared the number, type and length of after-hours spine surgery over three time periods: (A) June 1, 2016-May 31, 2017 (baseline control); (B) June 1, 2017-May 31, 2018 (implementation of retrospective quality care spine rounds); and (C) June 1, 2018-May 31, 2019 (implementation of CPMS). A qualitative analysis of the CPMS transcripts was also performed to assess the rate of between-surgeon agreement for timing and type of procedure. RESULTS The mean number of after-hours spine surgeries/month over the three study periods (A, B, C) was 10.83, 9.75 and 7.58 (p = 0.014); length of surgery was 41.82, 33.14 and 25.37 h/month (p = 0.001). Group agreement with the attending spine surgeon plan was 74.3% overall and was highest for the most urgent and least urgent types of indications. CONCLUSIONS Prospective (i.e., prior to booking surgery) quality care discussion for joint decision-making among spine surgeons using CPMS may reduce both the number and complexity of after-hours procedures.
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Affiliation(s)
- Amit R Persad
- Division of Neurosurgery, Royal University Hospital, University of Saskatchewan, Saskatoon, 103 Hospital Drive, Saskatoon, SK, S7N 0W8, Canada
| | - Rosalie Mercure-Cyr
- Division of Neurosurgery, Royal University Hospital, University of Saskatchewan, Saskatoon, 103 Hospital Drive, Saskatoon, SK, S7N 0W8, Canada
| | - Michael Spiess
- Division of Orthopedics, Royal University Hospital, University of Saskatchewan, Saskatoon, SK, Canada
| | - Allan Woo
- Division of Orthopedics, Royal University Hospital, University of Saskatchewan, Saskatoon, SK, Canada
| | - Zane Tymchak
- Division of Neurosurgery, Royal University Hospital, University of Saskatchewan, Saskatoon, 103 Hospital Drive, Saskatoon, SK, S7N 0W8, Canada
| | - Adam Wu
- Division of Neurosurgery, Royal University Hospital, University of Saskatchewan, Saskatoon, 103 Hospital Drive, Saskatoon, SK, S7N 0W8, Canada
| | - Luke Hnenny
- Division of Neurosurgery, Royal University Hospital, University of Saskatchewan, Saskatoon, 103 Hospital Drive, Saskatoon, SK, S7N 0W8, Canada
| | - Daryl R Fourney
- Division of Neurosurgery, Royal University Hospital, University of Saskatchewan, Saskatoon, 103 Hospital Drive, Saskatoon, SK, S7N 0W8, Canada.
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Lin ICF, Yoon AP, Kong L, Wang L, Chung KC. Association Between Daytime vs Overnight Digit Replantation and Surgical Outcomes. JAMA Netw Open 2022; 5:e2229526. [PMID: 36048443 PMCID: PMC9437749 DOI: 10.1001/jamanetworkopen.2022.29526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Recent evidence suggests that select delayed replantation may not adversely affect digit survival; however, whether surgical timing (overnight or daytime) is associated with digit replantation outcomes is unknown. OBJECTIVE To assess whether digit survival, complication rate, and duration of surgery are associated with time of replantation. DESIGN, SETTING, AND PARTICIPANTS This retrospective case series study included all replantations performed at a single tertiary referral academic center between January 1, 2000, and August 1, 2021. Data were analyzed between October 2, 2021, and January 1, 2022. Four daytime surgery intervals were selected based on literature review. Daytime replantations started within the intervals whereas overnight replantations began outside the intervals. For each case, the procedure difficulty score and the attending surgeon expertise score were calculated. Logistic and linear regressions adjusting for confounders including procedure difficulty score and expertise score were used to assess surgical timing and outcomes. Participants were adults (aged ≥18 years) undergoing digit replantations between January 2000 and August 2021 with at least 1-month follow-up. Replantation was defined as the reattachment of a completely amputated digit that necessitated anastomosis of both artery and vein. EXPOSURES Daytime or overnight digit replantation. MAIN OUTCOMES AND MEASURES Viable replanted digit at 1-month follow-up, number of complications, and duration of surgery. RESULTS A total of 98 patients (mean [SD] age, 39.5 [15.3] years; 136 [93%] men) and 147 digits met inclusion criteria. Overall success rate was 55%. Between 4 pm and 7 am, overnight replantations were associated with 0.4 fewer complications (β, -0.4; 95% CI, -0.8 to -0.1) and 90.7 minutes shorter operative time (β, -90.7; 95% CI, -173.6 to -7.7). A 1-point increase in surgeon expertise score was associated with 1.7 times increased odds of replantation success for all intervals (adjusted odds ratio, 1.7; 95% CI, 1.2 to 2.4; P = .002). There were no differences in digit survival by surgical time. CONCLUSIONS AND RELEVANCE In this case series study of digit replantations, time of operation was not associated with replantation success. Overnight replantation was associated with fewer complications and shorter duration of surgery compared with daytime surgery. Results of this study suggest that overnight replantations may be performed with outcomes comparable to daytime replantations at a tertiary care academic center.
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Affiliation(s)
- I-Chun F. Lin
- Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor
| | - Alfred P. Yoon
- Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor
| | - Lingxuan Kong
- School of Public Health, Department of Biostatistics, University of Michigan, Ann Arbor
| | - Lu Wang
- School of Public Health, Department of Biostatistics, University of Michigan, Ann Arbor
| | - Kevin C. Chung
- Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor
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9
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O'Neill NP, Hedequist DJ, Glotzbecker M, Cook D, Yang T, McCann ME, Chacko S, Cravero J, Hresko MT. Performing Multiple Posterior Spinal Fusions in 1 Day: A Comparison of Perioperative Outcomes Between Morning and Afternoon Cases. J Pediatr Orthop 2021; 41:e722-e726. [PMID: 34334697 DOI: 10.1097/bpo.0000000000001893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND High-volume centers for idiopathic scoliosis (IS) have difficulty in scheduling posterior spinal fusions (PSFs) due to operating room availability, particularly during school vacation. A solution is for 1 surgeon to perform 2 PSF cases back-to-back. This study aims to compare morning and afternoon PSF cases performed by the same surgeon for perioperative outcomes. METHODS A retrospective review of PSF cases for IS that occurred on the same day as another PSF by the same surgeon between January 2013 and December 2019 was conducted. Perioperative outcomes included surgical time, estimated blood loss, length of stay, and inpatient opioid consumption normalized by the patient's weight. Postoperative outcomes included complications, revision rate, curve correction, and patient-reported outcomes using the Scoliosis Research Society-30. RESULTS A total of 95 patients (87% female), mean age 15.6 years, were analyzed, with 48 morning cases and 47 afternoon cases. The median follow-up was 1.9 years (range: 0.3 to 6.1 y). Tests for equivalency determined equivalence in median anesthesia and mean surgical duration (P=0.05). The groups had similar initial curve correction (P=0.43) and rate of complications at 90 days postoperative (2 in each group for a total of 4 complications). No significant differences were seen between Scoliosis Research Society-30 scores at 6 months or in those who have reached 2 years postoperative. CONCLUSIONS Little literature exists on the safety of a surgeon performing 2 PSF cases in 1 day, particularly in regard to pain outcomes, 30- and 90-day complication rates, and quality of life measures. This study indicates that few differences in safety, pain, and quality of life outcomes may appear between morning and afternoon PSF cases. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
| | | | | | | | - Troy Yang
- Anesthesiology, Boston Children's Hospital
| | - Mary E McCann
- Anesthesiology, Boston Children's Hospital
- Harvard Medical School, Boston, MA
| | - Sabeena Chacko
- Anesthesiology, Boston Children's Hospital
- Harvard Medical School, Boston, MA
| | - Joseph Cravero
- Anesthesiology, Boston Children's Hospital
- Harvard Medical School, Boston, MA
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10
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Cortegiani A, Ippolito M, Misseri G, Helviz Y, Ingoglia G, Bonanno G, Giarratano A, Rochwerg B, Einav S. Association between night/after-hours surgery and mortality: a systematic review and meta-analysis. Br J Anaesth 2020; 124:623-637. [DOI: 10.1016/j.bja.2020.01.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 01/12/2020] [Accepted: 01/29/2020] [Indexed: 01/11/2023] Open
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