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Night-time versus daytime surgical outcomes in chronic subdural hematomas: a post hoc analysis of the FINISH randomized trial

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2024年10月22日

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  • Elias Oulasvirta,
  • Oula Knuutinen,
  • Pihla Tommiska,
  • Riku Kivisaari,
  • Rahul Raj,
  • Abdirisak Ahmed,
  • Tarmo Areda,
  • Jiri Bartek Jr,
  • Tomasz Czuba,
  • Nils Danner,
  • Antti-Pekka Elomaa,
  • Janek Frantzén,
  • Ilkka Haapala,
  • Joonas Haapasalo,
  • Juuso Heikkilä,
  • Minttu Hellman,
  • Henna Henttonen,
  • Nora Huuska,
  • Teppo LN Järvinen,
  • Henna-Kaisa Jyrkkänen,
  • Aku Kaipainen,
  • Olli-Pekka Kämäräinen,
  • Hanna Kämppi,
  • Milla Kelahaara,
  • Riku Kivisaari,
  • Nikolai Klimko,
  • Oula A Knuutinen,
  • Timo Koivisto,
  • Tommi Korhonen,
  • Janne Koskimäki,
  • Anselmi Kovalainen,
  • Xenia Kuparinen,
  • Dan Laukka,
  • Martin Lehecka,
  • Kai Lehtimäki,
  • Ville Leinonen,
  • Kimmo Lönnrot,
  • Antti Luikku,
  • Teemu Luostarinen,
  • Teemu Luoto,
  • Janne Luotonen,
  • Lauriina Lustig-Tammi,
  • Henna-Riikka Maanpää,
  • Jenni Määttä,
  • Timo Möttönen,
  • Eliisa Netti,
  • Laura Nevaharju-Sarantis,
  • Mika Niemelä,
  • Tero Niskakangas,
  • Mette Nissinen,
  • Ville Nurminen,
  • Minna Oinas,
  • Teemu Ollonen,
  • Anna Östberg,
  • Elias Oulasvirta,
  • Krista Pantzar,
  • Katri Piilonen,
  • Anni Pohjola,
  • Markus Polvivaara,
  • Jussi P Posti,
  • Rahul Raj,
  • Linnea Rajala,
  • Jonas Ranstam,
  • Minna Rauhala,
  • Behnam Rezai Jahromi,
  • Miika Roiha,
  • Ilkka Saarenpää,
  • Antti Sajanti,
  • Henrikki Salmi,
  • Jarno Satopää,
  • Christoph Schwartz,
  • Niina Shemeikka,
  • Pia Sorto,
  • Simo Taimela,
  • Sami Tetri,
  • Tuomo Thesleff,
  • Pihla Tommiska,
  • Maarit Tuomisto,
  • Nuutti Vartiainen,
  • Ville Vasankari,
  • Jyri Virta,
  • Mikko Visuri,
  • Paula Walle,
  • Frederick A Zeiler

摘要

Objective

The optimal timing of surgical intervention for chronic subdural hematomas (CSDH), specifically night-time versus daytime, remains a subject of debate, with concerns about the potential impact of circadian timing on surgical outcomes. This study evaluated the association between the timing of burr-hole drainage for CSDH and postoperative outcomes, comparing night-time and daytime surgeries.

Methods

In a post-hoc analysis of the FINISH trial, we included adult patients with symptomatic unilateral or bilateral CSDH who underwent burr-hole drainage between January 2020 and August 2022. Night-time surgery was defined as procedures starting between 23:00 and 06:00, with daytime surgeries occurring between 06:01 and 22:59. The primary outcome was functional outcome at six months post-surgery, assessed using the modified Rankin Scale (mRS), with favorable outcomes defined as an mRS of 0–3. Secondary outcomes included mortality, reoperation rates, and adverse events within six months.

Results

Our analysis of 589 patients (83% daytime surgery, 17% night-time surgery) revealed no significant differences in baseline characteristics. The unadjusted analysis suggested a higher rate of favorable functional outcomes in the night-time surgery group than in the daytime group (94% vs. 86%, p = 0.037). Mortality, adverse events, and reoperation rates were similar in the groups. Adjusted logistic regression analyses, accounting for potential confounders, indicated that night-time surgery was not associated with a higher risk of unfavorable functional outcomes compared to daytime surgery.

Conclusions

Our findings suggest that night-time surgery versus daytime surgery is not associated with worse postoperative outcomes. These findings challenges the traditional preference for daytime CSDH surgery and emphasizes the potential for flexibility in surgical scheduling to optimize patient care in CSDH management.