PMID- 30523460 OWN - NLM STAT- MEDLINE DCOM- 20200708 LR - 20200708 IS - 1432-0932 (Electronic) IS - 0940-6719 (Linking) VI - 28 IP - 4 DP - 2019 Apr TI - 'After-hours' non-elective spine surgery is associated with increased perioperative adverse events in a quaternary center. PG - 817-828 LID - 10.1007/s00586-018-5848-x [doi] AB - PURPOSE: 'After-hours' non-elective spinal surgeries are frequently necessary, and often performed under sub-optimal conditions. This study aimed (1) to compare the characteristics of patients undergoing non-elective spine surgery 'After-hours' as compared to 'In-hours'; and (2) to compare the perioperative adverse events (AEs) between those undergoing non-elective spine surgery 'after-hours' as compared to 'in-hours'. METHODS: In this retrospective study of a prospective non-elective spine surgery cohort performed in a quaternary spine center, surgery was defined as 'in-hours' if performed between 0700 and 1600 h from Monday to Friday or 'after-hours' if more than 50% of the operative time occurred between 1601 and 0659 h, or if performed over the weekend. The association of 'after-hours' surgery with AEs, surgical duration, intraoperative estimated blood loss (IOBL), length of stay and in-hospital mortality was analyzed using stepwise multivariate logistic regression. RESULTS: A total of 1440 patients who underwent non-elective spinal surgery between 2009 and 2013 were included in this study. A total of 664 (46%) procedures were performed 'after-hours'. Surgical duration and IOBL were similar. About 70% of the patients operated 'after-hours' experienced at least one AE compared to 64% for the 'in-hours' group (p = 0.016). 'After-hours' surgery remained an independent predictor of AEs on multivariate analysis [adjusted OR 1.30, 95% confidence interval (CI) 1.02-1.66, p = 0.034]. In-hospital mortality increased twofold in patients operated 'after-hours' (4.4% vs. 2.1%, p = 0.013). This association lost significance on multivariate analysis (adjusted OR 1.99, 95% CI 0.98-4.06, p = 0.056). CONCLUSION: Non-elective spine surgery performed 'after-hours' is independently associated with increased risk of perioperative adverse events, length of stay and possibly, mortality. Research is needed to determine the specific factors contributing to poorer outcomes with 'after-hours' surgery and strategies to minimize this risk. These slides can be retrieved under Electronic Supplementary Material. FAU - Charest-Morin, Raphaele AU - Charest-Morin R AUID- ORCID: 0000-0002-7689-1087 AD - Department of Orthopedic Surgery, Blusson Spinal Cord Centre, University of British Columbia, 6th Floor, 818 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada. Raphaele.charestmorin@vch.ca. FAU - Flexman, Alana M AU - Flexman AM AD - Department of Anesthesiology, Pharmacology and Therapeutics, Vancouver General Hospital, University of British Columbia, Room 2449 JPP 899 West 12th Avenue, Vancouver, BC, V5Z 1M9, Canada. FAU - Bond, Michael AU - Bond M AD - Department of Orthopaedic Surgery, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada. FAU - Ailon, Tamir AU - Ailon T AD - Department of Orthopedic Surgery, Blusson Spinal Cord Centre, University of British Columbia, 6th Floor, 818 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada. FAU - Dea, Nicolas AU - Dea N AD - Department of Orthopedic Surgery, Blusson Spinal Cord Centre, University of British Columbia, 6th Floor, 818 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada. FAU - Dvorak, Marcel AU - Dvorak M AD - Department of Orthopedic Surgery, Blusson Spinal Cord Centre, University of British Columbia, 6th Floor, 818 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada. FAU - Kwon, Brian AU - Kwon B AD - Department of Orthopedic Surgery, Blusson Spinal Cord Centre, University of British Columbia, 6th Floor, 818 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada. FAU - Paquette, Scott AU - Paquette S AD - Department of Orthopedic Surgery, Blusson Spinal Cord Centre, University of British Columbia, 6th Floor, 818 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada. FAU - Fisher, Charles G AU - Fisher CG AD - Department of Orthopedic Surgery, Blusson Spinal Cord Centre, University of British Columbia, 6th Floor, 818 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada. FAU - Street, John AU - Street J AD - Department of Orthopedic Surgery, Blusson Spinal Cord Centre, University of British Columbia, 6th Floor, 818 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada. LA - eng PT - Journal Article DEP - 20181206 PL - Germany TA - Eur Spine J JT - 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 JID - 9301980 SB - IM MH - Adult MH - After-Hours Care/*statistics & numerical data MH - Aged MH - Blood Loss, Surgical/statistics & numerical data MH - Cohort Studies MH - Elective Surgical Procedures/*statistics & numerical data MH - Female MH - Hospital Mortality MH - Humans MH - Intraoperative Complications/*etiology MH - Logistic Models MH - Male MH - Middle Aged MH - Neurosurgical Procedures/*statistics & numerical data MH - Operative Time MH - Retrospective Studies MH - Spinal Diseases/*surgery OTO - NOTNLM OT - Adverse event OT - Complication OT - In-hospital mortality OT - Intraoperative blood loss OT - Length of stay OT - Out of hours OT - Spine OT - Surgical duration OT - 'After-hours' EDAT- 2018/12/14 06:00 MHDA- 2020/07/09 06:00 CRDT- 2018/12/08 06:00 PHST- 2018/08/13 00:00 [received] PHST- 2018/11/30 00:00 [accepted] PHST- 2018/12/14 06:00 [pubmed] PHST- 2020/07/09 06:00 [medline] PHST- 2018/12/08 06:00 [entrez] AID - 10.1007/s00586-018-5848-x [pii] AID - 10.1007/s00586-018-5848-x [doi] PST - ppublish SO - Eur Spine J. 2019 Apr;28(4):817-828. doi: 10.1007/s00586-018-5848-x. Epub 2018 Dec 6.