Factors associated with extension of the scheduled time for spine surgery

Adherence to scheduled times in surgery is important in hospital management. However, sudden surgical changes or unexpected intraoperative problems may lead to prolongation of operative times. The purpose of this study was to investigate operative times in spinal surgery and to identify causes of delays during surgery.

A retrospective review of 488 cases of spinal surgery was performed to investigate operations prolonged for >2 h and to identify factors associated with prolongation.

There were 250 cases without a delay, and 144, 64, and 30 with delays of <1 h, 1-2 h, and >2 h, respectively. Delays >2 h were caused by interruptions due to loss of transcranial motor-evoked potential (Tc-MEP) signals in spinal cord monitoring (n = 15), reinsertion due to screw misplacement (n = 5), intraoperative pathology procedures (n = 5), extension of fusion range with instrumentation (n = 3), and complete resection of an intramedullary tumor (n = 2). Surgeries with delays >2 h (n = 30) had greater rates of scheduled surgery for >5 h (40% vs. 23%; P < 0.05), instrumentation use (70% vs. 47%; P < 0.05), reoperation (33% vs. 7%; P < 0.01%), and estimated blood loss (EBL) (1573 vs. 435 ml; P < 0.01), compared to all other surgeries (n = 458). In multivariate logistic regression, reoperation (HR 3.15, 95% CI 1.52-6.55; p < 0.01) and EBL ≥ 1000 ml (HR 3.35, 95% CI 1.56-7.18; p < 0.01) were significantly associated with prolongation of surgery by >2 h.

Information suggesting potential prolongation of surgery should be shared with all medical staff. Reliable surgical techniques and hemostasis may also reduce delays in surgery.