ARRIVING IN THE THEATRE IN THE MIDDLE OF THE NIGHT: HOW SAFE IS IT? – A REVIEW OF EARLY COMPLICATIONS IN SPINAL INTERVENTIONS ON EMERGENCY LISTS

Abstract

The current work compares, in the patients with acute spinal cord injuries (SCI), the rate of early complications in those who were operated ‘out of hours’ to the patients who had their surgical interventions performed on the elective trauma list.

In a two-year study, all the complications occurring within the first month of surgery were recorded. Patients who had their operative procedure between 22.00 pm and 8.00 am comprised the ‘out of hours’ group, while the other group included patients operated on daytime spinal trauma lists. Each group had 22 patients. The demographics, injury patterns, time relapse to admission and theatre, the surgical procedure, its duration, the postoperative results and early complications were retrospectively analysed and compared for the two groups.

There were 38 males. 20 patients had complete SCI and 26 had thoracic spine involvement. Road traffic accident was the cause of injury in 26 patients. Two patients received steroids following the injury. The average admission time was 3 days. Surgery occurred on an average within 48 h (range 1–20 days). The mean theatre time was 2.8 h for the emergency group and 3.4 h for the elective cases. Early postoperative complications were chest infections (5), urinary tract infections (7), superficial wound infections (2), and pulmonary embolism (1). The incidence of complications was higher in cervical injuries, polytrauma, complicated procedures and individuals requiring intensive care. No significant differences were noted between the two groups.

Operating non life-saving emergency cases on elective list constitutes good clinical practice. Various reviews including the National Confidential Enquiry into Patient Outcomes and Deaths (NCEPOD) suggest that operating out of working hours poses a substantial risk to the patient’s health and safety. This study emphasizes that complications relate to the injury level, associated injuries and the procedure itself, rather than to the timing of surgery.