Predictors and Impact of Operation Delays on Postoperative Outcomes Following Thoracolumbar Fixation

Introduction: Minimizing operation delays (ODs) is crucial, as they significantly impact patient recovery and outcomes. This study identifies key predictors of surgical delays and examines the effects of ODs on postoperative outcome.

Methods: Data from the ACS-NSQIP database was analyzed for thoracolumbar fixation cases from 2015 to 2019. Time to surgery was the primary outcome measure. Secondary outcomes included non-routine discharge (NRD), extended length of stay (eLOS), complications, 30-day readmission, and reoperation rates. Predictive performance was assessed using the area under the curve (AUC), and adjusted odds ratios (aORs) were calculated via logistic regression, adjusting for patient and surgical risk factors.

Results: In a cohort of 19,815 patients undergoing thoracolumbar fixation, the ROC analysis demonstrated that the compound score achieved the highest predictive accuracy, with an AUC of 0.809 (95% CI: 0.797–0.820). The Geriatric Nutritional Risk Index (GNRI) also performed well, with an AUC of 0.801 (0.789–0.812), and the DeLong test showed no significant difference between GNRI and the compound score. In comparison, the Risk Analysis Index and the American Society of Anesthesiologists Physical Status Classification, and the 5-factor modified frailty index had inferior predictive power, with AUCs of 0.681 (0.667–0.696), 0.677 (0.665–0.690), and 0.557 (0.543–0.572), respectively. Further analysis revealed significant associations between ODs and outcomes. Mortality had an aOR of 7.550 (5.815–9.802). NRD showed an aOR of 5.647 (5.191–6.142), while eLOS had an aOR of 6.370 (5.747–7.060). The odds of experiencing any complication were also elevated, with an aOR of 3.521 (3.245–3.821). For Clavien-Dindo Grade IV complications, the aOR was 4.211 (3.670–4.832). Additionally, unplanned readmission and reoperation had an aOR of 2.315 (2.051–2.614) and 2.082 (1.782–2.432), respectively.

Conclusion : The GNRI demonstrated strong predictive accuracy for ODs, highlighting the potential impact of timely nutritional interventions in reducing delays and improving surgical outcomes. These findings support the integration of preoperative nutritional assessments to optimize postoperative recovery in thoracolumbar fixation patients.