Case Start Timing of Adult Spinal Deformity Surgeries: Does the Wait Matter?

Adult spinal deformity (ASD) surgery can entail complex reconstructive procedures. It is unclear whether there is any effect of case start time on outcomes. We sought to evaluate the effects of case start time and day of the week on 90-day complication, readmission, and revision rates after ASD surgery.

This is a retrospective study of 1040 ASD patients from a single institution. We collected start times and day of the week for cases from 2011 to 2018. Early start was designated as any case starting either before or at 7:30 am or between 7:30 and 11 am; late start was designated as any case starting at 11 am or later. Outcome measures include 90-day complication, revision, and readmission rates.

A total of 1040 ASD patients (age, 46 ± 23 years; body mass index, 25 ± 7; American Society of Anesthesiologists classification, 2.5 ± 0.6; levels fused, 10 ± 4; three column osteotomy (3CO), 13%) were included. There was no association between surgery day of the week and length of stay, 90-day complication, readmission, or reoperation rates in the adjusted analyses. Late start cases had higher rates of 90-day readmission (10.5% vs 6.0%, P = 0.02), reoperation (11.9% vs 6.6%, P = 0.008), and neurologic injury (5.2% vs 2.1%, P = 0.019). Subanalysis of neurologic complications demonstrated that there was a higher rate of postoperative radiculopathy (P = 0.007) and residual central or foraminal stenosis (P = 0.029) in late start cases. A late start time was predictive of increased risk for 90-day readmission (OR 1.8, P = 0.02), unplanned reoperation (OR 1.9, P = 0.009), and neurologic complication (OR 2.1, P = 0.046).

A late OR start time was predictive of increased risk for neurologic complication, 90-day readmission, and unplanned reoperation. The well-established protocols for first start OR times for elective ASD surgery may decrease outcome risk and reduce variability in complication rates.

Understanding the impact of start time on outcomes and complications after ASD surgery is helpful for surgeons in preoperative planning and for institutions and hospitals' allocation of operating room staff and resources.