• Alan H Daniels, Mohammad Daher, Manjot Singh, Mariah Balmaceno-Criss, Renaud Lafage, Bassel G Diebo, David K Hamilton, Justin S Smith, Robert K Eastlack, Richard G Fessler, Jeffrey L Gum, Munish C Gupta, Richard Hostin, Khaled M Kebaish, Eric O Klineberg, Stephen J Lewis, Breton G Line, Pierce D Nunley, Gregory M Mundis, Peter G Passias, Themistocles S Protopsaltis, Thomas Buell, Justin K Scheer, Jeffrey P Mullin, Alex Soroceanu, Christopher P Ames, Lawrence G Lenke, Shay Bess, Christopher I Shaffrey, Douglas C Burton, Virginie Lafage, Frank J Schwab, and International Spine Study Group.
• Department of Orthopedics, Warren Alpert Medical School of Brown University, East Providence, RI.
• Spine. 2024 Mar 1; 49 (5): 313320313-320.

Study DesignRetrospective review of prospectively collected data.ObjectiveTo analyze the impact of operative room (OR) time in adult spinal deformity (ASD) surgery on patient outcomes.BackgroundIt is currently unknown if OR time in ASD patients matched for deformity severity and surgical invasiveness is associated with patient outcomes.Materials And MethodsASD patients with baseline and two-year postoperative radiographic and patient-reported outcome measures (PROM) data, undergoing a posterior-only approach for long fusion (>L1-Ilium) were included. Patients were grouped into short OR time (<40th percentile: <359 min) and long OR time (>60th percentile: >421 min). Groups were matched by age, baseline deformity severity, and surgical invasiveness. Demographics, radiographic, PROM data, fusion rate, and complications were compared between groups at baseline and two years follow-up.ResultsIn total, 270 patients were included for analysis: the mean OR time was 286 minutes in the short OR group versus 510 minutes in the long OR group ( P <0.001). Age, gender, percent of revision cases, surgical invasiveness, pelvic incidence minus lumbar lordosis, sagittal vertical axis, and pelvic tilt were comparable between groups ( P >0.05). Short OR had a slightly lower body mass index than the short OR group ( P <0.001) and decompression was more prevalent in the long OR time ( P =0.042). Patients in the long group had greater hospital length of stay ( P =0.02); blood loss ( P <0.001); proportion requiring intensive care unit ( P =0.003); higher minor complication rate ( P =0.001); with no significant differences for major complications or revision procedures ( P >0.5). Both groups had comparable radiographic fusion rates ( P =0.152) and achieved improvement in sagittal alignment measures, Oswestry disability index, and Short Form-36 ( P <0.001).ConclusionShorter OR time for ASD correction is associated with a lower minor complication rate, a lower estimated blood loss, fewer intensive care unit admissions, and a shorter hospital length of stay without sacrificing alignment correction or PROMs. Maximizing operative efficiency by minimizing OR time in ASD surgery has the potential to benefit patients, surgeons, and hospital systems.Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

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