The Role of Surgical Scheduling and Workflow in Cervical Spine Fusion Outcomes

by Vince Vacketta, DPM

Does the time of day a cervical spinal fusion begins, or whether the surgery crosses an operating room shift change, affect patient outcomes?

Researchers conducted a study examining three timing factors – case start time, operating room shift changes, and case order – to determine whether scheduling and workflow influence outcomes after cervical spinal fusion in patients with similar demographics and comorbidities.

Key study findings

• Intraoperative shift change: Associated with a 2.04-day longer length of stay and higher likelihood of non-home discharge.

• Later cases (2nd or beyond): Associated with a 1.62-day longer length of stay.

• Second case or later cases: Associated with lower odds of one-year revision spine surgery.

• Start time alone: Less influential than case order and shift transitions on patient outcomes overall.

Understanding the impact

These findings challenge the common assumption that later cases inevitably lead to worse outcomes due to surgeon fatigue or operating room inefficiency. Instead, case order may influence recovery logistics more than surgical success. Patients undergoing later cases in the day may stay in the hospital longer, especially if a shift change occurs, but longer-term surgical durability may not suffer – and may even improve.