Effect of Start Time, Intraoperative Shift Change, and Case Order on Outcomes After Cervical Spinal Fusion
By Admin | April 30, 2026
Effect of Start Time, Intraoperative Shift Change, and Case Order on Outcomes After Cervical Spinal Fusion
Dalton, Jonathan MD; Oris, Robert J. BS; Ezeonu, Teeto BA; Huang, Rachel BA; Narayanan, Rajkishen MD; Martinazzi, Brandon J. MD; DiCiurcio, William T. III DO; Lee, Yunsoo MD; Bradley, Evan BS; Siddiqui, Hassan BS; Swiderski, Thomas BS; LaBarbiera, Anthony BS; Micou, Lauren BS; Woods, Barrett I. MD; Kurd, Mark F. MD; Rihn, Jeffrey A. MD; Kaye, Ian David MD; Canseco, Jose MD, PhD; Hilibrand, Alan MD; Vaccaro, Alexander MD, PhD, MBA; Schroeder, Gregory MD; Kepler, Christopher MD, MBA
Abstract
Introduction:
With increasing orthopaedic surgical demand, the importance of operating room (OR) efficiency and safety is paramount. However, there is a lack of research regarding the effect of OR and staff workflow factors on postoperative outcomes. The purpose of this study was to evaluate the effect of OR workflow on outcomes after elective cervical fusion, with a focus on inpatient complications and discharge disposition.
Methods:
Adult patients who underwent primary cervical fusion (2020 to 2021) were retrospectively identified. OR workflow variables included (1) OR arrival before versus after 12 pm, (2) intraoperative shift change, and (3) case order. Outcomes included time to physical therapy, length of stay (LOS), inpatient complications, 90-day emergency department visits/readmissions, and 1-year revision surgery.
Results:
Four hundred sixty-three patients were included. Afternoon patients experienced more cardiopulmonary complications (P = 0.043) and longer LOS (P = 0.020). Intraoperative shift change was associated with longer and more commonly posterior surgery with more levels fused/decompressed (all P values < 0.05). Multivariable regression analyses demonstrated that an intraoperative shift change (estimate: 2.04, P < 0.001) and second or later case (estimate: 1.62, P = 0.002) were independently predictive of longer LOS when controlling for age, sex, body mass index, comorbidities...(More)
For more info please read, Effect of Start Time, Intraoperative Shift Change, and Case Order on Outcomes After Cervical Spinal Fusion, by The Journal of the AAOS
