Evolution of neurosurgical on-call activity at caen university hospital between 2014 and 2024: a retrospective...

Neurosurgical on call systems provide continuous access to specialised emergency care. International series report rising referral volumes, especially for spine, trauma, and low acuity consultations, but French decade long data within a continuous 24 h duty model are scarce.

We performed a retrospective single centre comparison at Caen University Hospital including all neurosurgical on call referrals over two 3 month periods (2014 and 2024). We recorded referral volume and origin, patient age, cranial versus spinal orientation, urgency level, operations during duty (including after midnight), and admissions. Groups were compared with standard tests for categorical and continuous variables.

Referrals increased from 432 to 1,354 (+214%), and mean calls per duty rose from 6.4 to 18.1 (p < 0.001). Referrals from peripheral hospitals increased (58%-69.5%), and community physician calls rose (1.1%-5.3%). Patients older than 85 years increased (7.2%-12.6%). Spinal referrals increased and reached parity with cranial referrals in 2024. Non urgent calls rose from 11.1% to 49.6%. Immediate emergency operations increased from 33 to 82, and post midnight procedures from 5 to 23.

Over 10 years, on call workload nearly tripled in our centre, with more spine cases, more low acuity requests, and more night time surgery. These trends support reorganising emergency pathways, implementing structured tele expertise, and adapting staffing to maintain sustainable neurosurgical emergency care.