Effect of Start Time, Intraoperative Shift Change, and Case Order on Outcomes After Cervical Spinal Fusion

Area of Science:

• Orthopaedic Surgery
• Health Services Research
• Patient Safety

Background:

• Increasing demand for orthopaedic surgery necessitates optimized operating room (OR) efficiency and safety.
• Limited research exists on the impact of OR and staff workflow factors on postoperative outcomes.
• This study investigates OR workflow effects on outcomes following elective cervical fusion.

Purpose of the Study:

• To evaluate the influence of operating room workflow on patient outcomes after elective cervical fusion.
• To specifically examine the impact of OR workflow on inpatient complications and discharge disposition.

Main Methods:

• Retrospective analysis of adult patients undergoing primary cervical fusion between 2020 and 2021.
• OR workflow variables included: afternoon OR arrival, intraoperative shift change, and case order.
• Outcomes assessed: time to physical therapy, length of stay (LOS), inpatient complications, 90-day ED visits/readmissions, and 1-year revision surgery.

Main Results:

• Afternoon surgeries were linked to more cardiopulmonary complications and longer LOS.
• Intraoperative shift change correlated with longer surgery, posterior approaches, and more fused/decompressed levels.
• Shift changes and later case orders independently predicted longer LOS (2.04 and 1.62 days, respectively).
• Shift changes predicted decreased home discharge, while later cases predicted lower 1-year revision surgery odds.

Conclusions:

• Intraoperative shift changes significantly increase LOS and non-home discharge rates.
• Later case orders in cervical fusion surgery are associated with longer LOS but reduced 1-year revision rates.
• Further research is warranted to elucidate the mechanisms behind these workflow-outcome associations.