Jeremy C Heard, Teeto Ezeonu, Yunsoo Lee, Rajkishen Narayanan, Tariq Issa, Cordero McCall, Yoni Dulitzki, Dylan Resnick, Jeffrey Zucker, Alexander Shaer, Mark Kurd, Alan S Hilibrand, Alexander R Vaccaro, Christopher K Kepler, Gregory D Schroeder, Jose A Canseco
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Previous literature suggests that there may be an adverse effect to having surgery on the weekend.</p><p><strong>Methods: </strong>All patients ≥18 years who underwent primary lumbar spinal fusion from 2014 to 2020 were retrospectively identified. Patients were subdivided into an early subgroup (surgery between Monday and Wednesday) and a late subgroup (surgery between Thursday and Friday). Surgical outcome variables included inpatient complications, 90-day readmissions, and 1-year revisions. PT data from the first inpatient PT session included hours to PT session, AM-PAC Daily Activity or Basic Mobility scores, and total gait trial distance achieved.</p><p><strong>Results: </strong>Of the 1239 patients identified, 839 had surgery between Monday and Wednesday and 400 had surgery between Thursday and Friday. Patients in the later surgery subgroup were more likely to experience a nonsurgical neurologic complication (3.08% vs. 0.86%, P =0.008); however, there was no difference in total complications. Patients in the early surgery subgroup had their first inpatient PT session earlier than patients in the late subgroup (15.7 vs. 18.9 h, P <0.001). However, patients in the late subgroup achieved a farther total gait distance (98.2 vs. 75.4, P =0.011). Late surgery was a significant predictor of more hours of PT (est.=0.256, P =0.016) and longer length of stay (est.=2.277, P =0.001). There were no significant differences in readmission and revision rates.</p><p><strong>Conclusions: </strong>Patients who undergo surgery later in the week may experience more nonsurgical neurologic complications, longer wait times for inpatient PT appointments, and longer lengths of stay. 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Patients in the later surgery subgroup were more likely to experience a nonsurgical neurologic complication (3.08% vs. 0.86%, P =0.008); however, there was no difference in total complications. Patients in the early surgery subgroup had their first inpatient PT session earlier than patients in the late subgroup (15.7 vs. 18.9 h, P <0.001). However, patients in the late subgroup achieved a farther total gait distance (98.2 vs. 75.4, P =0.011). Late surgery was a significant predictor of more hours of PT (est.=0.256, P =0.016) and longer length of stay (est.=2.277, P =0.001). There were no significant differences in readmission and revision rates.</p><p><strong>Conclusions: </strong>Patients who undergo surgery later in the week may experience more nonsurgical neurologic complications, longer wait times for inpatient PT appointments, and longer lengths of stay. 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引用次数: 0
摘要
研究设计回顾性队列研究：本研究的目的是调查工作日腰椎融合手术是否会影响手术和住院物理治疗（PT）的效果：背景数据摘要：手术时机被认为是影响脊柱手术后疗效的一个因素。以前的文献表明，在周末进行手术可能会产生不利影响：方法：对2014年至2020年期间接受初级腰椎融合术的所有年龄≥18岁的患者进行回顾性鉴定。患者被细分为早期亚组（周一至周三手术）和晚期亚组（周四至周五手术）。手术结果变量包括住院并发症、90 天再入院率和 1 年复查率。首次住院PT疗程的PT数据包括到PT疗程的时间、AM-PAC日常活动或基本活动能力评分以及达到的步态试验总距离：在已确认的1239名患者中，839人在周一至周三期间进行了手术，400人在周四至周五期间进行了手术。晚手术亚组患者更有可能出现非手术神经并发症（3.08% vs. 0.86%，P=0.008）；但总并发症没有差异。早期手术亚组患者的首次住院PT疗程早于晚期手术亚组患者（15.7小时 vs. 18.9小时，PC结论：在一周内晚些时候接受手术的患者可能会经历更多的非手术神经并发症、更长的住院PT预约等待时间和更长的住院时间。这项分析表明，工作日晚些时候进行手术对总并发症、再入院和再手术没有不利影响：证据等级：三级。
Impact of Weekday on Short-term Surgical Outcomes After Lumbar Fusion Surgery.
Study design: Retrospective cohort study.
Objective: The purpose of this study is to investigate whether weekday lumbar spine fusion surgery has an impact on surgical and inpatient physical therapy (PT) outcomes.
Summary of background data: Timing of surgery has been implicated as a factor that may impact outcomes after spine surgery. Previous literature suggests that there may be an adverse effect to having surgery on the weekend.
Methods: All patients ≥18 years who underwent primary lumbar spinal fusion from 2014 to 2020 were retrospectively identified. Patients were subdivided into an early subgroup (surgery between Monday and Wednesday) and a late subgroup (surgery between Thursday and Friday). Surgical outcome variables included inpatient complications, 90-day readmissions, and 1-year revisions. PT data from the first inpatient PT session included hours to PT session, AM-PAC Daily Activity or Basic Mobility scores, and total gait trial distance achieved.
Results: Of the 1239 patients identified, 839 had surgery between Monday and Wednesday and 400 had surgery between Thursday and Friday. Patients in the later surgery subgroup were more likely to experience a nonsurgical neurologic complication (3.08% vs. 0.86%, P =0.008); however, there was no difference in total complications. Patients in the early surgery subgroup had their first inpatient PT session earlier than patients in the late subgroup (15.7 vs. 18.9 h, P <0.001). However, patients in the late subgroup achieved a farther total gait distance (98.2 vs. 75.4, P =0.011). Late surgery was a significant predictor of more hours of PT (est.=0.256, P =0.016) and longer length of stay (est.=2.277, P =0.001). There were no significant differences in readmission and revision rates.
Conclusions: Patients who undergo surgery later in the week may experience more nonsurgical neurologic complications, longer wait times for inpatient PT appointments, and longer lengths of stay. This analysis showed no adverse effect of later weekday surgery as it relates to total complications, readmissions, and reoperations.
期刊介绍：
Clinical Spine Surgery is the ideal journal for the busy practicing spine surgeon or trainee, as it is the only journal necessary to keep up to date with new clinical research and surgical techniques. Readers get to watch leaders in the field debate controversial topics in a new controversies section, and gain access to evidence-based reviews of important pathologies in the systematic reviews section. The journal features a surgical technique complete with a video, and a tips and tricks section that allows surgeons to review the important steps prior to a complex procedure.
Clinical Spine Surgery provides readers with primary research studies, specifically level 1, 2 and 3 studies, ensuring that articles that may actually change a surgeon’s practice will be read and published. Each issue includes a brief article that will help a surgeon better understand the business of healthcare, as well as an article that will help a surgeon understand how to interpret increasingly complex research methodology. Clinical Spine Surgery is your single source for up-to-date, evidence-based recommendations for spine care.
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