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Published on: August 6, 2019
Effect of Start Time, Intraoperative Shift Change, and Case Order on Outcomes After Cervical Spinal Fusion
Jonathan Dalton1, Robert J Oris, Teeto Ezeonu
1From the Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA.
Introduction:
With increasing orthopaedic surgical demand, the importance of operating room (OR) efficiency and safety is paramount. However, there is a lack of research regarding the effect of OR and staff workflow factors on postoperative outcomes. The purpose of this study was to evaluate the effect of OR workflow on outcomes after elective cervical fusion, with a focus on inpatient complications and discharge disposition.
Methods:
Adult patients who underwent primary cervical fusion (2020 to 2021) were retrospectively identified. OR workflow variables included (1) OR arrival before versus after 12 pm , (2) intraoperative shift change, and (3) case order. Outcomes included time to physical therapy, length of stay (LOS), inpatient complications, 90-day emergency department visits/readmissions, and 1-year revision surgery.
Results:
Four hundred sixty-three patients were included. Afternoon patients experienced more cardiopulmonary complications ( P = 0.043) and longer LOS ( P = 0.020). Intraoperative shift change was associated with longer and more commonly posterior surgery with more levels fused/decompressed (all P values < 0.05). Multivariable regression analyses demonstrated that an intraoperative shift change (estimate: 2.04, P < 0.001) and second or later case (estimate: 1.62, P = 0.002) were independently predictive of longer LOS when controlling for age, sex, body mass index, comorbidities, number of levels fused/decompressed, procedure time, time from OR to first physical therapy session, and inpatient complications. An intraoperative shift change was predictive of decreased home discharge (odds ratio: 0.47, P = 0.030). Non-first-case surgery was associated with lower odds of 1-year revision surgery (odds ratio: 0.41, P = 0.018).
Conclusion:
In a cohort of patients with similar demographics and comorbidities, intraoperative shift changes independently predicted increased LOS (2.04 days longer) and nonhome discharge, and second-case or later case order independently predicted LOS (1.62 days longer). However, second-case or later case order independently predicted lower odds of 1-year spine revision surgery. Additional work is needed to evaluate the potential reasons for these findings.
