Afternoon Surgical Start Time Is Associated with Higher Cost and Longer Length of Stay in Posterior Lumbar Fusion.

BACKGROUND: Existing research about surgical start time is equivocal about associations between outcomes and late start times, and there is only one published report investigating start time in spine surgery. Therefore, the objective of this study was to assess associations between surgical start time, length of stay (LOS), and cost in lumbar spine surgery. METHODS: Patients at a single institution undergoing posterior lumbar fusion (PLF) were grouped based on whether they received their surgery before or after 2 pm, with those receiving their surgery between 12 am and 6 am and receiving surgery for tumors, trauma, or infections being excluded. These 2 groups were then compared on the basis of demographics and outcomes with cost and LOS as the coprimary outcomes. RESULTS: A total of 2977 patients underwent PLF during the study period. There were minimal differences in preoperative characteristics of the cohorts. The patients who underwent PLF starting after 2 pm had longer LOS (0.45 days; 95% confidence interval [CI], 0.18-0.72; P = 0.001) and higher costs ($1343; 95% CI, $339-$2348; P = 0.009) than cases starting before 2 pm The late surgical start cohort also had higher rates of nonhome discharge (29.73% vs. 23.17%, P = 0.0004), and 30-day (4.36% vs. 2.5%, P = 0.01) and 90-day emergency department visits (5.72% vs. 2.94%, P = 0.0005). CONCLUSIONS: Late surgical start time is associated with longer LOS and higher cost in patients undergoing PLF.

A case of adult α-type spinal deformity with spinal cord rotation greater than 90°.

This report describes a 42-year-old man who presented with an α-type spinal deformity with a Cobb angle of 224.9° and associated spinal cord rotation greater than 90°. Preoperative imaging revealed extensive spinal deformity, and 3D modeling confirmed the α-type nature of his deformity. Intraoperative photography demonstrated spinal cord rotation greater than 90°, which likely contributed to the patient's poor neurological status. Reports of patients with Cobb angles ≥ 100° are rare, and to the authors' knowledge, there have been no published cases of adult α-type spinal deformity. Furthermore, very few cases or case series of spinal cord rotation have been published previously, with no single patient having rotation greater than 90° to the authors' knowledge. Given these two rarities presenting in the same patient, this report can provide important insights into the operative management of this difficult form of spinal deformity.