• Baig MirzaAsfandADepartment of Neurosurgery, King's College Hospital National Health Service Foundation Trust, London, United Kingdom. Electronic address: asfand.mirza@nhs.net., Maria Alexandra Velicu, Richard Lyon, Amisha Vastani, Timothy Boardman, Qusai Al Banna, Christopher Murphy, Christopher Kellett, Ahilan Kailaya Vasan, and Gordan Grahovac.
• Department of Neurosurgery, King's College Hospital National Health Service Foundation Trust, London, United Kingdom. Electronic address: asfand.mirza@nhs.net.
• World Neurosurg. 2022 Mar 1; 159: e208-e220.

BackgroundCauda equina syndrome (CES) can have devastating neurological sequelae if surgical treatment is delayed. However, out-of-hours surgery (weekdays from 6:00 pm to 8:00 am and all weekend operations) can potentially result in higher rates of intraoperative complications, resulting in worse outcomes. In the present study, we have described our outcomes for patients with CES during an 8-year period (December 2011 to October 2019) with the aim of assessing the risk of out-of-hours surgery.MethodsWe performed a retrospective analysis of inpatient events and outcomes at 6 months of follow-up. Patient demographics, symptoms, and management data were extracted, and a risk factor analysis was performed using logistic regression. The outcome measures were the incidence of complications and symptom changes at follow-up. Symptom outcome changes between 2 time points were analyzed using repeated measures.ResultsA total of 278 patients were included in the present study. Surgery out-of-hours (P = 0.018) and prolonged operations (P = 0.018) were significant risk factors for intraoperative complications. Improved outcomes at 6 months of follow-up were found for lower back pain, sciatica, altered saddle sensation, and urinary sphincter disturbance, with no significant changes for the remaining symptoms. Out-of-hours surgeries did not significantly affect individual symptom outcomes.ConclusionsOur analysis has suggested that emergency decompressive surgery for patients with CES does not result in worsening of outcomes with out-of-hours surgery compared with in-hours. However, our findings also showed that no clear benefit exists to expediting surgery for those with severe presentations. Thus, decompressive surgery should be undertaken at the earliest possible time to safely do so.Crown Copyright © 2021. Published by Elsevier Inc. All rights reserved.

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