Prone Positioning In The Elderly Extends Perioperative Process Times: A Retrospective Analysis

Objective: Cervical bone fractures describe a predominant trauma in the elderly. With demographic change, prone patient positions might create further stress on personnel resources. Therefore, the aim of this study was to conduct an age-related analysis of pre- and intraoperative process times in patients with cervical fractures.Methods: We reviewed all schedules with cervical spine surgery performed at a tertiary hospital. Two different operative patient positions were specified: prone and supine. We retrospectively analysed three study groups: comparison group (group 1:<= 59 years of age), old patients (group 2: 60-79 years), and very old patients (group 3: >= 80 years). We recorded date and kind of surgery, biometric data, and process times by screening recordings of internal software programs (COPRA (R) and SAP 710 (R)). Group comparisons were conducted using the Kruskal-Wallis test with Dunn's post hoc test and Bonferroni correction, Pearson's chi-square test, and the Mann-Whitney U test, as required.Results: 330 patients (202 male; 128 female) were analysed. The number of patients in the resulting age-dependent groups 1-3 were n=102, n=123, and n=105, respectively. Patients of increasing age and in supine position showed a continuous increase in the time needed for anaesthesia induction (mean between 4 and 8 minutes (p<0.05). When compared to patients in supine position, this time further increased on average by 6 minutes (p<0.05) in old but prone patients. In old and very old patients, getting a patient into a prone position was associated with a time demand between 10 and 12 minutes (p<0.01), respectively. While time for surgery age-dependently decreased in patients that were supine positioned (p<0.001), surgery time was prolonged between 34 and 104 minutes (p<0.05) in patients that were prone.Conclusion: With prone position both anaesthesia-controlled and surgical-controlled times extended in patients of increasing age. With regard to demographic change, this aspect should be considered for future revenue calculations in flat-rate remuneration systems.