James F Bathon, Omar Zakieh, Claudia Davidson, Alicia M Hymel, Jacquelyn S Pennings, Mason W Young, Mitchell Bowers, Julian G Lugo-Pico, Raymond J Gardocki, Scott L Zuckerman, Byron F Stephens, Amir M Abtahi
These results suggest that delaying the second stage may be more a question of resource utilization rather than concern for a negative impact on patient outcomes. Surgeons should acknowledge that either staging strategy, same-day or delayed, results in equivalent clinical outcomes with some differences in perioperative outcomes. The choice to delay second-stage surgery should be patient-centered and consider institutional factors.
BACKGROUND: Two-stage, anterior and posterior, cervical spine surgery is often utilized for complex spinal pathologies. The second stage may be performed on the same day or delayed to a separate day. A variety of considerations influence this decision, yet comprehensive and broad analyses examining predictors and outcomes of same-day versus delayed staging remain limited.
METHODS: A retrospective cohort study was conducted to investigate the effects of same-day versus delayed staging on complications and surgical outcomes. Adults undergoing two-stage cervical procedures were identified using the Quality Outcomes Database. The primary exposure was delaying the second-stage surgery to a separate day, termed the delayed second stage. Demographic, clinical, and preoperative data were analyzed. Outcomes included patient-reported outcome measures (PROMs) and reoperation rates at 3, 12, and 24 months, as well as the 30-day complication rate.
RESULTS: Among 394 patients (mean age 60.8±10.7, 52.0% male), 27.9% had delayed second-stage surgery, the majority had an anterior approach as the first stage (87.8%), and patients who had delayed second-stage surgery were less likely to have American Society of Anesthesiologists scores ≥3 (43.6% vs. 64.5%, p<0.001). Patients with delayed second-stage surgery had longer operative times (326±37.0 vs. 293±34.0 minutes, p=0.022) and longer hospital stays (4.4±0.79 vs. 3.1±0.54 days, p<0.001), with no significant differences in blood loss, reoperation rates, PROMs at 3, 12, and 24 months, or 30-day complication rates (all p>0.05).
CONCLUSIONS: These results suggest that delaying the second stage may be more a question of resource utilization rather than concern for a negative impact on patient outcomes. Surgeons should acknowledge that either staging strategy, same-day or delayed, results in equivalent clinical outcomes with some differences in perioperative outcomes. The choice to delay second-stage surgery should be patient-centered and consider institutional factors.