LAUSR

OBJECTIVE The "after-hours" effect on postoperative complications has been poorly studied in the neurosurgical literature. A recent retrospective analysis demonstrated that patients with a surgical start time (SST) between 21:01 and 07:00 had a greater risk of complications. This study used a prospective registry to examine the relationship between SST and postoperative complications in a large neurosurgical population. METHODS We performed a prospective, longitudinal cohort analysis of all consecutive adult patients admitted to our neurosurgery service between 10/01/2018 and 05/01/2019. Complications were prospectively recorded and classified as surgical or medical. Univariate and multivariate logistic regressions were utilized to analyze these data. RESULTS Eighty-five (6.6%) surgical complications and 110 (8.6%) medical complications resulted from 1,285 operations on 1,145 patients. Later SST was predictive of complications in the emergent population (OR 2.28, 95% CI 1.01-5.15, P = 0.048) but not in the elective population. Extubation in the neurosurgical ICU (NICU) versus the OR strongly predicted medical complications (OR 6.91, 95% CI 3.33-14.34, P < 0.0001). Patients with a later SST were significantly more likely to be extubated in the NICU (P < 0.0001). CONCLUSIONS Patients undergoing emergent operations with a later SST were significantly more likely to have a postoperative complication. Patients who were extubated in the NICU versus the OR were significantly more likely to have a medical complication. Patients were more likely to get extubated in the NICU if they had a later SST; therefore, SST may indirectly be associated with an increase in medical complications.