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Nighttime surgery increases complication risk in chronic subdural hematoma: a population-based cohort study
Sanna Clementsson1, Ali Buwaider2,3, Jiri Bartek2,3,4
1Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden. sanna.clementsson@stud.ki.se.
Acta Neurochirurgica
|December 3, 2025
Summary
Nighttime surgery for chronic subdural hematoma (CSDH) increases complication risk. Performing CSDH evacuation during daytime hours is recommended when possible to improve patient outcomes.
Area of Science:
- Neurosurgery
- Surgical Outcomes
- Patient Safety
Background:
- Night surgeries may pose risks due to provider fatigue and staffing.
- Limited data exists on nighttime neurosurgical procedures, specifically for CSDH.
- This study investigates the impact of nighttime CSDH surgery.
Purpose of the Study:
- To evaluate the association between nighttime CSDH surgery and complications.
- To assess if nighttime CSDH surgery increases the risk of recurrence.
- To provide evidence-based recommendations for CSDH surgical timing.
Main Methods:
- Retrospective cohort study of adult CSDH patients (2006-2023).
- Primary exposure: nighttime surgery (procedure start time).
- Outcomes: moderate-to-severe complications and CSDH recurrence; adjusted for confounders using logistic regression.
Main Results:
- 25% of 2860 CSDH surgeries were performed at night.
- Nighttime surgery independently linked to higher moderate-to-severe complication risk (OR 1.58).
- Recurrence risk was not significantly different after adjusting for confounders.
Conclusions:
- Nighttime CSDH surgery is associated with increased moderate-to-severe complications.
- The risk of complications was highest during the late night hours.
- Daytime surgery for CSDH is preferable when feasible to enhance patient safety.
