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Adult spinal deformity surgery: the effect of surgical start time on patient outcomes and cost of care

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A Correction to this article was published on 18 May 2020

This article has been updated

Abstract

Purpose

There are reports investigating the effect of surgical start time (SST) on outcomes, length of stay (LOS) and cost in various surgical disciplines. However, this has not been studied in spine deformity surgery to date. This study compares outcomes for patients undergoing spinal deformity surgery based on SST.

Methods

Patients at a single academic institution from 2008 to 2016 undergoing elective spinal deformity surgery (defined as fusing ≥ 7 segments) were divided by SST before or after 2 PM. Co-primary outcomes were LOS and direct costs. Secondary outcomes included delayed extubation, ICU stay, complications, reoperation, non-home discharge, and readmission rates.

Results

There were 373 surgeries starting before 2 PM and 79 after 2 PM. The cohorts had similar demographics including age, sex, comorbidity burden, and levels fused. The late SST cohort had shorter operation durations (p = 0.0007). Multivariable linear regression showed no differences in LOS (estimate 0.4 days, CI − 1.2 to 2.0, p = 0.64) or direct cost (estimate $3652, 95% CI − $1449 to $8755, p = 0.16). Multivariable logistic regression revealed the late SST cohort was more likely to have delayed extubation (OR 2.6, 95% CI 1.4–4.9, p = 0.004) and non-home discharge (OR 2.2, 95% CI 1.1–4.2, p = 0.03). All other secondary outcomes were non-significant.

Conclusion

Patients undergoing spinal deformity surgery before and after 2 PM have similar LOS and cost of care. However, the late SST cohort had increased likelihood of delayed extubation and non-home discharges, which increase cost in bundled payment models. These findings can be utilized in OR scheduling to optimize outcomes and minimize cost.

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Change history

  • 18 May 2020

    The original version of this article unfortunately contained a mistake. The first name of the author “Samuel Z. Maron” was incorrectly provided as “Sam” instead of “Samuel”.

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Funding

No financial or material support was received for this study.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, 50 East 98th St, Apartment 7D-4, New York, NY, 10029, USA

    William H. Shuman, Sean N. Neifert, Michael L. Martini, Alexander J. Schupper, Jeremy M. Steinberger, Samuel Z. Maron, Colin D. Lamb, Robert J. Rothrock, Ian T. McNeill, Samuel K. Cho & John M. Caridi

  2. Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Jonathan S. Gal

  3. Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Samuel K. Cho

Authors
  1. William H. Shuman
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  2. Sean N. Neifert
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  7. Samuel Z. Maron
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Contributions

WHS: Made substantial contributions to project design and manuscript drafting, approved the version, and agreed to be accountable for all its aspects. SNN: Made substantial contributions to project design and manuscript revisions, approved the version, and agreed to be accountable for all its aspects. JSG: Made substantial contributions to data acquisition and manuscript revisions, approved the version, and agreed to be accountable for all its aspects. MLM: Made substantial contributions to data acquisition and manuscript revisions, approved the version, and agreed to be accountable for all its aspects. AJS: Made substantial contributions to project design and manuscript revisions, approved the version, and agreed to be accountable for all its aspects. JMS: Made substantial contributions to project design and manuscript revisions, approved the version, and agreed to be accountable for all its aspects. SZM: Made substantial contributions to data analysis and manuscript revisions, approved the version, and agreed to be accountable for all its aspects. CDL: Made substantial contributions to data acquisition and manuscript revisions, approved the version, and agreed to be accountable for all its aspects. RJR: Made substantial contributions to project conception and manuscript revisions, approved the version, and agreed to be accountable for all its aspects. ITM: Made substantial contributions to project design and manuscript revisions, approved the version, and agreed to be accountable for all its aspects. SKC: Made substantial contributions to project conception and manuscript revisions, approved the version, and agreed to be accountable for all its aspects. JMC: Made substantial contributions to project conception and manuscript revisions, approved the version, and agreed to be accountable for all its aspects.

Corresponding author

Correspondence to William H. Shuman.

Ethics declarations

Conflicts of interest

Dr. Cho serves as a paid consultant to Globus Medical, Zimmer Biomet, and CGBio Inc., and has served as a member of the American Academy of Orthopaedic Surgeons, the American Orthopaedic Association, the AOSpine North America, the Cervical Spine Research Society, the North American Spine Society, and the Scoliosis Research Society.

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This manuscript contains no copyrighted materials or signed patient consent forms.

Ethical approval

Approval obtained from institution’s Institutional Review Board: HS# 16-00565.

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The original version of this article was revised: The original version of this article unfortunately contained a mistake. The first name of the author “Samuel Z. Maron” was incorrectly provided as “Sam” instead of “Samuel”.

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Shuman, W.H., Neifert, S.N., Gal, J.S. et al. Adult spinal deformity surgery: the effect of surgical start time on patient outcomes and cost of care. Spine Deform 8, 1017–1023 (2020). https://doi.org/10.1007/s43390-020-00129-x

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