Work

Nighttime surgery increases complication risk in chronic subdural hematoma: a population-based cohort study

Year: 2025

Type: article

Abstract: BACKGROUND: Surgeries performed at night may carry higher risk due to provider fatigue and reduced staffing, but data from neurosurgical populations are limited. We evaluated whether nighttime evacuation of chronic subdural hematoma (CSDH) was associated with increased complications or recurrence. METHODS: We conducted a retrospective cohort study of adults undergoing CSDH surgery at a tertiary neurosurgical center between 2006 and 2023. The primary exposure was nighttime surgery, defined by procedure start time. Primary outcomes were moderate-to-severe complications (Landriel-Ibáñez grade II-IV within 30 days) and CSDH recurrence (reoperation within 6 months). Multivariable logistic regression was used to adjust for confounders. RESULTS: Of 2860 patients, 709 (25%) underwent nighttime surgery. Nighttime surgery was independently associated with an increased risk of moderate-to-severe complications (OR 1.58, 95% CI 1.04-2.37; p = 0.028). This risk peaked during the final hours of the night shift. Although CSDH recurrence was more common after nighttime surgery in unadjusted analysis (13% vs. 10%), this difference was not significant after confounder adjustment. CONCLUSION: Nighttime surgery for CSDH was associated with an increased risk of moderate-to-severe complications. When feasible, surgery should be performed during daytime hours.

Source: Acta Neurochirurgica

DOI: 10.1007/s00701-025-06714-1

Authors: Sanna Clementsson, Ali Buwaider, Jiri Bartek, Alexander Fletcher-Sandersjöö

Institutions: Karolinska Institutet, Karolinska University Hospital

Language: English

Topic: Neurosurgical Procedures and Complications

Subfield: Neurology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $3,990