Abstract
To the editor,
Recently, we have had the great honor of reading the article “Does Surgical Day of the Week Affect Hospital Course and Outcomes for Patients Undergoing Adult Spinal Deformity Surgery?” by Graham et al 1 In this study, the authors collected 256 patients who underwent adult spinal deformity (ASD) surgery, including 126 patients in the early-week surgeries and 130 patients in the late-week surgeries, to explore the impact of surgical day of the week on length of stay (LOS), which greatly fills a gap in this field. Results showed no difference in mean LOS between surgeries performed early in the week and later in the week. Notably, although the risk of readmission at 30 days postoperatively was higher in the late-week group, there were no significant differences in other outcomes. Furthermore, all differences had largely disappeared with longer postoperative follow-up (1 year). We would like to thank the authors very much for their contribution. However, there are still some issues in this article that need to be further explored.
First, the authors collected detailed information on patients’ baseline demographic variables and intraoperative factors that may affect LOS. However, the authors only classified patients according to the American Society of Anesthesiologists for pre-anesthetic patient fitness status and surgical risk without considering the impact of the mode of anesthesia on patient prognosis when analyzing anesthesiology. Currently, there have been studies demonstrating that different types of anesthesia may significantly affect patient activity and LOS. Specifically, peripheral nerve block was associated with slower activity and longer hospital stays, while epidural anesthesia was associated with faster activity and shorter hospital stays. 2 Moreover, how anesthetic medications are administered can alter somatosensory evoked potentials (SSEP), thereby affecting timely assessment and feedback from surgeons. The impact of intravenous anesthesia agents on SSEP signals is much lesser extent than inhaled agents. 3 In addition to cardiovascular disease, hypertension, and hyperlipidemia, differences in a patient’s preoperative pulmonary function can have an impact on prognosis. For instance, a retrospective study including 298 ASD found a correlation between preoperative lung function and the incidence of postoperative complications, with patients with preoperative forceful lung volumes (FVC) < 30% having a postoperative respiratory complication rate 18 times that of patients with normal preoperative lung function. 4 Moreover, the incidence of severe postoperative respiratory complications in adolescent patients (FVC <30%, age <19 years) with both respiratory disease and scoliosis was 58%, which was much higher than that in the group with normal lung function. 5 However, differences in respiratory disease between the 2 groups were not analyzed in this paper. Therefore, we suggest that respiratory diseases should be adequately analyzed before performing postoperative risk assessment.
Finally, we would like to thank the authors again for their contribution to this study. We hope that our views will be useful to the authors for further research and look forward to hearing from them.
