• Nathaniel R Ellens, Stephen Susa, Ricky Hoang, Tanzy Love, Jeremiah Jones, Gabrielle Santangelo, Matthew T Bender, and Thomas K Mattingly.
• Department of Neurosurgery, University of Rochester, Rochester, New York, USA. Electronic address: Nathaniel_ellens@urmc.rochester.edu.
• World Neurosurg. 2024 Jan 1; 181: e703e712e703-e712.

ObjectiveSurgery performed at night and on weekends is thought to be associated with increased complications. However, the impact of time of day on outcomes has not been studied within cranial neurosurgery. We aim to determine if there are differences in outcomes for cranial neurosurgery performed after hours (AH) compared with during hours (DH).MethodsWe performed a single-center retrospective study of cranial neurosurgery patients who underwent emergent surgery from January 2015 through December 2019. Surgery was considered DH if the incision occurred between 8 am and 5 pm Monday through Friday. We assessed outcome measures for differences between operations performed DH or AH.ResultsThree-hundred and ninety-three patients (114 DH, 279 AH) underwent surgery. There was a lower rate of return to the operating room within 30 days for AH (8.6%) compared with DH (14.0%), P = 0.03, on multivariate analysis. There were no significant differences in length of operation, estimated blood loss, improvement in Glasgow Coma Scale, intensive care unit and total hospital length of stay, 30-day readmission, 30-day mortality, and in-hospital mortality for cases performed DH compared with AH. Further subgroup analyses were performed for patients who underwent immediate surgery for subdural hematomas, with no differences noted in outcomes on multivariate analysis.ConclusionsThis study suggests that operating AH does not appear to negatively impact outcomes when compared with operating DH, in cases of cranial neurosurgical emergencies. Further study assessing the impact on elective neurosurgical cases is required.Copyright © 2023 Elsevier Inc. All rights reserved.

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