Is Cauda Equina Surgery Safe Out-of-Hours? A Single United Kingdom Institute Experience
Published research co-authored by Mr Gordan Grahovac
This study reviewed whether cauda equina syndrome surgery performed out of hours was associated with different outcomes or complications. It matters because CES surgery is often time-sensitive, but emergency timing must be balanced with safe surgical conditions.
Research snapshot
Article title: Is Cauda Equina Surgery Safe Out-of-Hours? A Single United Kingdom Institute Experience
Authors: Asfand Baig Mirza, Maria Alexandra Velicu, Richard Lyon, Amisha Vastani, Timothy Boardman, Qusai Al Banna, Christopher Murphy, Christopher Kellett, Ahilan Kailaya Vasan, Gordan Grahovac
Publication type: Journal article
Publication date: 14 December 2021
Publication details: World Neurosurgery. 2022;159:e208-e220.
PMID: 34915208
PMCID:
DOI: 10.1016/j.wneu.2021.12.028
Study type: Single-centre retrospective study
Mr Grahovac’s involvement: Listed author on the publication
Original publication: View the original publication on PubMed
What this paper looked at
This study examined cauda equina syndrome operations performed at a UK institute and compared issues related to out-of-hours surgery. The clinical question was whether emergency surgery outside routine hours was associated with safety concerns or worse outcomes.
Key points from the publication
The publication record confirms the article topic, journal, date and DOI. The abstract explains that delayed CES surgery can have serious neurological consequences, while out-of-hours surgery may carry practical and operative risks.
Clinical relevance
The paper is relevant to surgical timing, emergency operating practice and service planning for cauda equina syndrome.
What this means in context
The study does not mean all CES operations should or should not be performed out of hours. Decisions depend on urgency, neurological status, bladder function, imaging, operating-team availability and patient safety.
View the original publication
The following abstract is reproduced from the original publication and is provided for reference. It may include technical terminology intended for clinical or academic audiences.
Background: Cauda equina syndrome (CES) can have devastating neurological sequelae if surgical treatment is delayed. However, out-of-hours surgery (weekdays from 6:00 pm to 8:00 am and all weekend operations) can potentially result in higher rates of intraoperative complications, resulting in worse outcomes. In the present study, we have described our outcomes for patients with CES during an 8-year period (December 2011 to October 2019) with the aim of assessing the risk of out-of-hours surgery.
Methods: We performed a retrospective analysis of inpatient events and outcomes at 6 months of follow-up. Patient demographics, symptoms, and management data were extracted, and a risk factor analysis was performed using logistic regression. The outcome measures were the incidence of complications and symptom changes at follow-up. Symptom outcome changes between 2 time points were analyzed using repeated measures.
Results: A total of 278 patients were included in the present study. Surgery out-of-hours (P = 0.018) and prolonged operations (P = 0.018) were significant risk factors for intraoperative complications. Improved outcomes at 6 months of follow-up were found for lower back pain, sciatica, altered saddle sensation, and urinary sphincter disturbance, with no significant changes for the remaining symptoms. Out-of-hours surgeries did not significantly affect individual symptom outcomes.
Conclusions: Our analysis has suggested that emergency decompressive surgery for patients with CES does not result in worsening of outcomes with out-of-hours surgery compared with in-hours. However, our findings also showed that no clear benefit exists to expediting surgery for those with severe presentations. Thus, decompressive surgery should be undertaken at the earliest possible time to safely do so.
Keywords: CES; Cauda equina syndrome; Out-of-hours; Outcomes; Surgery; Timing.
View the original publication on PubMed
About Mr Gordan Grahovac
Mr Gordan Grahovac is a Consultant Neurosurgeon and Complex Spinal Surgeon with expertise in managing complex spinal and neurosurgical conditions.
His work includes the assessment and treatment of patients with degenerative spinal conditions, spinal cord compression, spinal tumours, complex spinal pathology and conditions requiring specialist neurosurgical input.
His approach focuses on careful diagnosis, appropriate treatment planning and helping patients understand their options clearly.
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