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Background <p>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.</p> Methods <p>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&#xa0;days) and CSDH recurrence (reoperation within 6&#xa0;months). Multivariable logistic regression was used to adjust for confounders.</p> Results <p>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; <i>p</i> = 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.</p> Conclusion <p>Nighttime surgery for CSDH was associated with an increased risk of moderate-to-severe complications. When feasible, surgery should be performed during daytime hours.</p>

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

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年12月3日

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  • Sanna Clementsson,
  • Ali Buwaider,
  • Jiri Bartek,
  • Alexander Fletcher-Sandersjöö

摘要

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.