Surgical Start Time Is Not Predictive of Microdiscectomy Outcomes.
Journal
Clinical spine surgery
ISSN: 2380-0194
Titre abrégé: Clin Spine Surg
Pays: United States
ID NLM: 101675083
Informations de publication
Date de publication:
01 03 2021
01 03 2021
Historique:
received:
20
02
2020
accepted:
24
07
2020
entrez:
26
2
2021
pubmed:
27
2
2021
medline:
26
10
2021
Statut:
ppublish
Résumé
Retrospective analysis of clinical data from a single institution. The objective of this study was to assess the time of surgery as a possible predictor for outcomes, length of stay, and cost following microdiscectomy. The volume of microdiscectomy procedures has increased year over year, heightening interest in surgical outcomes. Previous investigations have demonstrated an association between time of procedures and clinical outcomes in various surgeries, however, no study has evaluated its influence on microdiscectomy. Demographic and outcome variables were collected from all patients that underwent a nonemergent microdiscectomy between 2008 and 2016. Patients were divided into 2 cohorts: those receiving surgery before 2 pm were assigned to the early group and those with procedures beginning after 2 pm were assigned to the late group. Outcomes and patient-level characteristics were compared using bivariate, multivariable logistic, and linear regression models. Adjusted length of stay and cost were coprimary outcomes. Secondary outcomes included operative complications, nonhome discharge, postoperative emergency department visits, or readmission rates. Of the 1261 consecutive patients who met the inclusion criteria, 792 were assigned to the late group and 469 were assigned to the early group. There were no significant differences in demographics or baseline characteristics between the 2 cohorts. In the unadjusted analysis, mean length of stay was 1.80 (SD=1.82) days for the early group and 2.00 (SD=1.70) days for the late group (P=0.054). Mean direct cost for the early cohort was $5088 (SD=$4212) and $4986 (SD=$2988) for the late cohort (P=0.65). There was no difference in adjusted length of stay or direct cost. No statistically significant differences were found in operative complications, nonhome discharge, postoperative emergency department visits, or readmission rates between the 2 cohorts. The study findings suggest that early compared with late surgery is not significantly predictive of surgical outcomes following microdiscectomy.
Sections du résumé
STUDY DESIGN
Retrospective analysis of clinical data from a single institution.
OBJECTIVE
The objective of this study was to assess the time of surgery as a possible predictor for outcomes, length of stay, and cost following microdiscectomy.
SUMMARY OF BACKGROUND DATA
The volume of microdiscectomy procedures has increased year over year, heightening interest in surgical outcomes. Previous investigations have demonstrated an association between time of procedures and clinical outcomes in various surgeries, however, no study has evaluated its influence on microdiscectomy.
METHODS
Demographic and outcome variables were collected from all patients that underwent a nonemergent microdiscectomy between 2008 and 2016. Patients were divided into 2 cohorts: those receiving surgery before 2 pm were assigned to the early group and those with procedures beginning after 2 pm were assigned to the late group. Outcomes and patient-level characteristics were compared using bivariate, multivariable logistic, and linear regression models. Adjusted length of stay and cost were coprimary outcomes. Secondary outcomes included operative complications, nonhome discharge, postoperative emergency department visits, or readmission rates.
RESULTS
Of the 1261 consecutive patients who met the inclusion criteria, 792 were assigned to the late group and 469 were assigned to the early group. There were no significant differences in demographics or baseline characteristics between the 2 cohorts. In the unadjusted analysis, mean length of stay was 1.80 (SD=1.82) days for the early group and 2.00 (SD=1.70) days for the late group (P=0.054). Mean direct cost for the early cohort was $5088 (SD=$4212) and $4986 (SD=$2988) for the late cohort (P=0.65). There was no difference in adjusted length of stay or direct cost. No statistically significant differences were found in operative complications, nonhome discharge, postoperative emergency department visits, or readmission rates between the 2 cohorts.
CONCLUSION
The study findings suggest that early compared with late surgery is not significantly predictive of surgical outcomes following microdiscectomy.
Identifiants
pubmed: 33633067
doi: 10.1097/BSD.0000000000001063
pii: 01933606-202103000-00014
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
E107-E111Informations de copyright
Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
J.M.C. has received consultation fees from Zimmer Biomet. The remaining authors declare no conflict of interest.
Références
Caspar WWüllenweber R, Brock M, Hamer J, Klinger M, Spoerri O. A new surgical procedure for lumbar disc herniation causing less tissue damage through a microsurgical approach. Lumbar Disc Adult Hydrocephalus Advances in Neurosurgery. Berlin, Heidelberg: Springer; 1977:74–80.
Yasargil MWüllenweber R, Brock M, Hamer J, Klinger M, Spoerri O. Microsurgical operation of herniated lumbar disc. Lumbar Disc Adult Hydrocephalus Advances in Neurosurgery. Berlin, Heidelberg: Springer; 1977:81–86.
Bhatia PS, Chhabra HS, Mohapatra B, et al. Microdiscectomy or tubular discectomy: is any of them a better option for management of lumbar disc prolapse. J Craniovertebr Junction Spine. 2016;7:146–152.
Porchet F, Bartanusz V, Kleinstueck FS, et al. Microdiscectomy compared with standard discectomy: an old problem revisited with new outcome measures within the framework of a spine surgical registry. Eur Spine J. 2009;18(suppl 3):360–366.
Sorlie A, Gulati S, Giannadakis C, et al. Open discectomy vs microdiscectomy for lumbar disc herniation—a protocol for a pragmatic comparative effectiveness study. F1000Res. 2016;5:2170.
Truumees E, Geck M, Stokes JK, et al. Lumbar microdiscectomy. JBJS Essent Surg Tech. 2016;6:e3.
Deyo RA. Back surgery—who needs it? N Engl J Med. 2007;356:2239–2243.
Peul WC, van Houwelingen HC, van den Hout WB, et al. Surgery versus prolonged conservative treatment for sciatica. N Engl J Med. 2007;356:2245–2256.
Gibson JN, Waddell G. Surgical interventions for lumbar disc prolapse: updated Cochrane review. Spine (Phila Pa 1976). 2007;32:1735–1747.
Overley SC, McAnany SJ, Andelman S, et al. Return to play in elite athletes after lumbar microdiscectomy: a meta-analysis. Spine (Phila Pa 1976). 2016;41:713–718.
Dohrmann GJ, Mansour N. Long-term results of various operations for lumbar disc herniation: analysis of over 39,000 patients. Med Princ Pract. 2015;24:285–290.
Shriver MF, Xie JJ, Tye EY, et al. Lumbar microdiscectomy complication rates: a systematic review and meta-analysis. Neurosurg Focus. 2015;39:E6.
Ishiyama Y, Ishida F, Ooae S, et al. Surgical starting time in the morning versus the afternoon: propensity score matched analysis of operative outcomes following laparoscopic colectomy for colorectal cancer. Surg Endosc. 2019;33:1769–1776.
Yount KW, Lau CL, Yarboro LT, et al. Late operating room start times impact mortality and cost for nonemergent cardiac surgery. Ann Thorac Surg. 2015;100:1653–1658; discussion 1658–1659.
Kelz RR, Tran TT, Hosokawa P, et al. Time-of-day effects on surgical outcomes in the private sector: a retrospective cohort study. J Am Coll Surg. 2009;209:434.e2–445.e2.
Kelz RR, Freeman KM, Hosokawa PW, et al. Time of day is associated with postoperative morbidity: an analysis of the national surgical quality improvement program data. Ann Surg. 2008;247:544–552.
Govindarajan A, Urbach DR, Kumar M, et al. Outcomes of daytime procedures performed by attending surgeons after night work. N Engl J Med. 2015;373:845–853.
Heller JA, Kothari R, Lin HM, et al. Surgery start time does not impact outcome in elective cardiac surgery. J Cardiothorac Vasc Anesth. 2017;31:32–36.
Ou R, Ramos G, Bowles C, et al. Are nonemergent cardiac operations performed during off-time associated with worse outcome? J Surg Res. 2017;218:348–352.
Lu Q, Shen Y, Zhang J, et al. Operation start times and postoperative morbidity from liver resection: a propensity score matching analysis. World J Surg. 2017;41:1100–1109.
Slaughter KN, Frumovitz M, Schmeler KM, et al. Minimally invasive surgery for endometrial cancer: does operative start time impact surgical and oncologic outcomes? Gynecol Oncol. 2014;134:248–252.
Guidry CA, Davies SW, Willis RN, et al. Operative start time does not affect post-operative infection risk. Surg Infect (Larchmt). 2016;17:547–551.
Eskesen TG, Peponis T, Saillant N, et al. Operating at night does not increase the risk of intraoperative adverse events. Am J Surg. 2018;216:19–24.
Saklad M. Grading of patients for surgical procedures. Anesthesiology. 1941;2:281–284.
Doyle DJ, Garmon EH. American Society of Anesthesiologists Classification (ASA Class). Treasure Island, FL: StatPearls; 2019.
Quan H, Sundararajan V, Halfon P, et al. Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative Data. Med Care. 2005;43:1130–1139.
van Walraven C, Austin PC, Jennings A, et al. A modification of the Elixhauser comorbidity measures into a point system for hospital death using administrative data. Med Care. 2009;47:626–633.
Camino Willhuber G, Kido G, Mereles M, et al. Factors associated with lumbar disc hernia recurrence after microdiscectomy. Rev Esp Cir Ortop Traumatol. 2017;61:397–403.
Carragee EJ, Han MY, Suen PW, et al. Clinical outcomes after lumbar discectomy for sciatica: the effects of fragment type and anular competence. J Bone Joint Surg Am. 2003;85:102–108.
Keskimaki I, Seitsalo S, Osterman H, et al. Reoperations after lumbar disc surgery: a population-based study of regional and interspecialty variations. Spine (Phila Pa 1976). 2000;25:1500–1508.
Teng TY, Khor SN, Kailasam M, et al. Morning colonoscopies are associated with improved adenoma detection rates. Surg Endosc. 2016;30:1796–1803.
Keswani A, Beck C, Meier KM, et al. Day of surgery and surgical start time affect hospital length of stay after total hip arthroplasty. J Arthroplasty. 2016;31:2426–2431.
Khechen B, Haws BE, Patel DV, et al. Does the day of the week affect length of stay and hospital charges following anterior cervical discectomy and fusion? Int J Spine Surg. 2019;13:296–301.
Sanaka MR, Shah N, Mullen KD, et al. Afternoon colonoscopies have higher failure rates than morning colonoscopies. Am J Gastroenterol. 2006;101:2726–2730.
Mayo BC, Massel DH, Bohl DD, et al. Effect of surgery start time on day of discharge in anterior cervical discectomy and fusion patients. Spine (Phila Pa 1976). 2016;41:1939–1944.
Lang SS, Chen HI, Koch MJ, et al. Development of an outpatient protocol for lumbar discectomy: our institutional experience. World Neurosurg. 2014;82:897–901.
Paeck KH, Heo WJ, Park DI, et al. Colonoscopy scheduling influences adenoma and polyp detection rates. Hepatogastroenterology. 2013;60:1647–1652.
Long MD, Martin C, Sandler RS, et al. Reduced polyp detection as endoscopy shift progresses: experience with screening colonoscopy at a tertiary-care hospital. J Clin Gastroenterol. 2011;45:253–258.
Munson GW, Harewood GC, Francis DL. Time of day variation in polyp detection rate for colonoscopies performed on a 3-hour shift schedule. Gastrointest Endosc. 2011;73:467–475.
Eun CS, Han DS, Hyun YS, et al. The timing of bowel preparation is more important than the timing of colonoscopy in determining the quality of bowel cleansing. Dig Dis Sci. 2011;56:539–544.
Saadat H, Bissonnette B, Tumin D, et al. Time to talk about work-hour impact on anesthesiologists: the effects of sleep deprivation on profile of mood states and cognitive tasks. Paediatr Anaesth. 2016;26:66–71.
Wu J, Zhao S-B, Wang S-L, et al. Comparison of efficacy of colonoscopy between the morning and afternoon: a systematic review and meta-analysis. Dig Liver Dis. 2018;50:661–667.
Halvachizadeh S, Teuber H, Cinelli P, et al. Does the time of day in orthopedic trauma surgery affect mortality and complication rates? Patient Safety Surg. 2019;13:8.
Badiyan SN, Ferraro DJ, Yaddanapudi S, et al. Impact of time of day on outcomes after stereotactic radiosurgery for non-small cell lung cancer brain metastases. Cancer. 2013;119:3563–3569.
Chacko AT, Ramirez MA, Ramappa AJ, et al. Does late night hip surgery affect outcome? J Trauma. 2011;71:447–453; discussion 453.
Linzey JR, Burke JF, Sabbagh MA, et al. The effect of surgical start time on complications associated with neurological surgeries. Neurosurgery. 2018;83:501–507.
Sinha A, Singh A, Tewari A. The fatigued anesthesiologist: a threat to patient safety? J Anaesthesiol Clin Pharmacol. 2013;29:151–159.
Kwon YS, Jang JS, Hwang SM, et al. Effects of surgery start time on postoperative cortisol, inflammatory cytokines, and postoperative hospital day in hip surgery: randomized controlled trial. Medicine. 2019;98:e15820.
Sessler DI, Kurz A, Saager L, et al. Operation timing and 30-day mortality after elective general surgery. Anesth Analg. 2011;113:1423–1428.
George TJ, Arnaoutakis GJ, Merlo CA, et al. Association of operative time of day with outcomes after thoracic organ transplant. JAMA. 2011;305:2193–2199.
Tan PJ, Xu M, Sessler DI, et al. Operation timing does not affect outcome after coronary artery bypass graft surgery. Anesthesiology. 2009;111:785–789.
Seow YY, Alkari B, Dyer P, et al. Cold ischemia time, surgeon, time of day, and surgical complications. Transplantation. 2004;77:1386–1389.