The Effect of Surgical Start Time on Complications Associated With Neurological Surgeries

Abstract BACKGROUND Neurosurgical procedures are necessary at all times of day. Other surgical specialties have examined the effect of surgical start time (SST) on morbidity and mortality; however, a similar study has not been performed for neurosurgical procedures. OBJECTIVE To perform a retrospective cohort study describing the association between SST and operative morbidity. METHODS We analyzed all patients undergoing neurological surgery between January 1, 2007 and August 1, 2014 at our institution. This study included 15 807 patients. A total of 785 complications were identified through the self-reported morbidity and mortality reports created by faculty and resident neurosurgeons. We used multilevel logistic regression to investigate the association of SST with morbidity. RESULTS In multilevel logistic regression, our Baseline model demonstrated that the odds of complication increased by more than 50% for start times between 21:01 and 07:00 (odds ratio [OR] 1.53, 95% confidence interval [CI] 1.03-2.29, P = .04). When accounting for the length of the surgery, the odds of a complication were even greater for later time periods 21:01 to 07:00 (OR 2.16, 95% CI 1.44-3.23, P < .001). The only statistically significant factor that predicted severity of the complication was if the operation was emergent compared to elective (OR 1.70, 95% CI 1.11-2.60, P = .02). An SST between 21:01 and 07:00 substantially contributed when severe complications were isolated (OR 1.61, 95% CI 1.50-2.90, P = .08). CONCLUSION Patients with SSTs between 21:01 and 07:00 are at an increased risk of developing morbidity compared to patients with an SST earlier in the day.