Night-time versus daytime surgical outcomes in chronic subdural hematomas: a post hoc analysis of the FINISH randomized trial
Authors: Oulasvirta Elias , Knuutinen Oula , Tommiska Pihla , Kivisaari Riku , Raj Rahul ,   the FINISH study group, Ahmed Abdirisak , Areda Tarmo , Bartek Jiri , Czuba Tomasz , Danner Nils , Elomaa Antti-Pekka , Frantzén Janek , Haapala Ilkka , Haapasalo Joonas , Heikkilä Juuso , Hellman Minttu , Henttonen Henna , Huuska Nora , Järvinen Teppo LN , Jyrkkänen Henna-Kaisa , Kaipainen Aku , Kämäräinen Olli-Pekka , Kämppi Hanna , Kelahaara Milla , Kivisaari Riku , Klimko Nikolai , Knuutinen Oula A , Koivisto Timo , Korhonen Tommi , Koskimäki Janne , Kovalainen Anselmi , Kuparinen Xenia , Laukka Dan , Lehecka Martin , Lehtimäki Kai , Leinonen Ville , Lönnrot Kimmo , Luikku Antti , Luostarinen Teemu , Luoto Teemu , Luotonen Janne , Lustig-Tammi Lauriina , Maanpää Henna-Riikka , Määttä Jenni , Möttönen Timo , Netti Eliisa , Nevaharju-Sarantis Laura , Niemelä Mika , Niskakangas Tero , Nissinen Mette , Nurminen Ville , Oinas Minna , Ollonen Teemu , Östberg Anna , Oulasvirta Elias , Pantzar Krista , Piilonen Katri , Pohjola Anni , Polvivaara Markus , Posti Jussi P , Raj Rahul , Rajala Linnea , Ranstam Jonas , Rauhala Minna , Rezai Jahromi Behnam , Roiha Miika , Saarenpää Ilkka , Sajanti Antti , Salmi Henrikki , Satopää Jarno , Schwartz Christoph , Shemeikka Niina , Sorto Pia , Taimela Simo , Tetri Sami , Thesleff Tuomo , Tommiska Pihla , Tuomisto Maarit , Vartiainen Nuutti , Vasankari Ville , Virta Jyri , Visuri Mikko , Walle Paula , Zeiler Frederick A 
Published: October 2024

Abstract

Objective
The optimal timing of surgical intervention for chronic subdural hematomas (CSDH), specifically night-time versus daytime, remains a subject of debate, with concerns about the potential impact of circadian timing on surgical outcomes. This study evaluated the association between the timing of burr-hole drainage for CSDH and postoperative outcomes, comparing night-time and daytime surgeries.

Methods
In a post-hoc analysis of the FINISH trial, we included adult patients with symptomatic unilateral or bilateral CSDH who underwent burr-hole drainage between January 2020 and August 2022. Night-time surgery was defined as procedures starting between 23:00 and 06:00, with daytime surgeries occurring between 06:01 and 22:59. The primary outcome was functional outcome at six months post-surgery, assessed using the modified Rankin Scale (mRS), with favorable outcomes defined as an mRS of 0–3. Secondary outcomes included mortality, reoperation rates, and adverse events within six months.

Results
Our analysis of 589 patients (83% daytime surgery, 17% night-time surgery) revealed no significant differences in baseline characteristics. The unadjusted analysis suggested a higher rate of favorable functional outcomes in the night-time surgery group than in the daytime group (94% vs. 86%, p = 0.037). Mortality, adverse events, and reoperation rates were similar in the groups. Adjusted logistic regression analyses, accounting for potential confounders, indicated that night-time surgery was not associated with a higher risk of unfavorable functional outcomes compared to daytime surgery.

Conclusions
Our findings suggest that night-time surgery versus daytime surgery is not associated with worse postoperative outcomes. These findings challenges the traditional preference for daytime CSDH surgery and emphasizes the potential for flexibility in surgical scheduling to optimize patient care in CSDH management.