01 Apr Does Length of Surgery Matter?
Although most patients often ask how long their surgery will take, we never stress the importance of a quicker procedure and what that may mean for outcome. Most clinicians mistake “quicker” for “hastier” although that is not true. An efficient surgery is based on the same steps from beginning to end each and every time, without change. For those surgeons who like to try different technologies frequently, an element of unknown is introduced into a common procedure thereby increasing the risk for problems. I am frequently asked to try different devices for the Anterior Cervical Procedure and the simple fact is that it works well and works well with my technique. Like any craft, surgical procedures require years of practice and reducing the operation to a series of repeatable steps that allow success. Added steps that are not necessary introduce risk and error.
Most patients whom undergo a one-level or two-level anterior cervical procedure are discharged to home the same day. Although the incision is made on the front of the neck, there is a thin muscle to dissect (platysma) and then almost no other muscular dissection reducing overall pain. Because we place retractors in the neck to perform the surgery, greater operative time leads to greater retraction time and that can affect swallowing in the postoperative period. Sore neck and swallowing problems can be one reason patients need to stay in the hospital for added time.
Brain & Spine Surgeons of New York recently review our Anterior Cervical Spine Data from 2012 – 2018 with records from 774 patients. We analyzed length of surgery compared to length of stay in the hospital by surgeon, and there was a direct correlation showing that those surgeons with an average operative time over 100 minutes had an average length of stay over 1 day whereas those surgeons with an operative time under 100 minutes had most patients discharged the same day.
In summary, length of surgical time does matter.
- Zeiden et al. Predictors of Readmission and Prolonged Length of Stay After Cervical Disc Arthroplasty. Spine (Phila PA 1976). 46(8):487-491, 2021.