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The Effect of After-Hours Resection on the Outcomes in Patients with High-Grade Gliomas

Published online by Cambridge University Press:  05 November 2024

Karan Dhillon Open the ORCID record for Karan Dhillon [Opens in a new window] ,
Michael A. Rizzuto Open the ORCID record for Michael A. Rizzuto [Opens in a new window] ,
Mostafa Fatehi Open the ORCID record for Mostafa Fatehi [Opens in a new window]  and
Serge Makarenko Open the ORCID record for Serge Makarenko [Opens in a new window]
Karan Dhillon
Affiliation:
Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
Michael A. Rizzuto
Affiliation:
Division of Neurosurgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada
Mostafa Fatehi
Affiliation:
Division of Neurosurgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada
Serge Makarenko*
Affiliation:
Division of Neurosurgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada
*
Corresponding author: Serge Makarenko; Email: [email protected]
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Abstract

Objective:

The “weekend effect” is the finding that patients presenting for medical care outside of regular working hours tend to have worse outcomes. There is a paucity of literature in the neuro-oncology space exploring this effect. We investigated the extent of resection and complication rates in patients undergoing after-hours high-grade glioma resection.

Methods:

A retrospective review was conducted on patients with high-grade glioma requiring emergent surgery between January 1, 2021, and March 31, 2023. After hours was defined as surgical resection on the weekend and/or evening (>50% of surgical time between 1630 and 0659). These patients were matched to patients undergoing resection during regular working hours. Groups were compared on the basis of the extent of resection, postoperative complications and 6-month mortality rate.

Results:

A total of 38 patients were included in this study (19 after hours, 19 regular hours). There was no significant difference in age, sex, tumor grade and tumor size between the two groups (all p > 0.05). There was no significant difference in the extent of resection between the groups (p = 0.7442). There was no significant difference in the rate of intraoperative complications, postoperative complications, reoperation and death at 6 months between the groups (all p > 0.05). Estimated blood loss was significantly higher in the regular hours group (p = 0.0278). There was no significant difference in the total operative time (p = 0.0643) and length of stay (p = 0.0601).

Conclusions:

After-hours high-grade glioma surgery has similar outcomes to regular-hours surgery for lesions not requiring specialized functional mapping.

Résumé

RÉSUMÉ

Les effets de la résection chirurgicale effectuée après des heures normales de travail sur l’évolution de l’état de santé de patients atteints de gliomes de haut grade.

Objectif :

On constate, quand il est question de l’« effet week-end », que les patients qui se présentent pour obtenir des soins médicaux en dehors des heures normales de travail tendent à voir leur état de santé évoluer moins favorablement. Dans le domaine de la neuro-oncologie, la littérature explorant cet effet demeure peu abondante. À ce sujet, nous nous sommes penchés sur l’étendue des interventions de résection et sur les taux de complication chez des patients ayant subi une résection de gliome de haut grade en dehors des heures normales de travail.

Méthodes :

Nous avons mené une étude rétrospective sur des patients atteints de gliome de haut grade nécessitant une chirurgie émergente, et ce, entre le 1er janvier 2021 et le 31 mars 2023. Une chirurgie en dehors des heures normales de travail a été définie comme une résection survenant le week-end et/ou le soir (> 50 % du temps chirurgical entre 16 h 30 et 6 h 59). Ces patients ont été jumelés à d’autres patients ayant subi une résection pendant des heures normales de travail. Ces groupes de patients ont été ensuite comparés sur la base de l’étendue de la résection, des complications postopératoires et du taux de mortalité au bout de 6 mois.

Résultats :

Au total, 38 patients ont été inclus dans cette étude (19 après les heures normales de travail ; 19 pendant les heures normales). Aucune différence notable entre les deux groupes n’est apparue en ce qui concerne l’âge, le sexe, le grade des tumeurs et leur taille (tous les p > 0,05). Il n’y a pas eu non plus de différence significative dans l’étendue de la résection entre les groupes (p = 0,7442). Plus encore, aucune différence significative n’a émergé entre les deux groupes en ce qui concerne le taux de complications peropératoires, de complications postopératoires, de ré-opération et de décès au bout de 6 mois (tous les p > 0,05). La perte de sang estimée était significativement plus élevée dans le groupe des « heures normales » (p = 0,0278). Enfin, nous n’avons pas relevé de différence notable dans le temps opératoire total (p = 0,0643) et la durée du séjour (p = 0,0601).

Conclusions :

Dans le cas de lésions ne nécessitant pas de cartographie fonctionnelle spécialisée, la chirurgie des gliomes de haut grade en dehors des heures normales de travail sous-tend une évolution de l’état des patients similaire à celle de la chirurgie effectuée pendant des heures normales de travail.

Keywords

Gliomamalignantresectionneuro-oncologyafter-hours
Type
Original Article
Information
Canadian Journal of Neurological Sciences , First View , pp. 1 - 5
Copyright
© The Author(s), 2024. Published by Cambridge University Press on behalf of Canadian Neurological Sciences Federation

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