Cauda equina syndrome (CES) can have devastating neurological sequelae if surgical treatment is delayed. Out-of-hours surgeries (weekdays 1800-0800 and all weekend operations) can potentially result in higher rates of intra-operative complications, resulting in worse outcomes. In this study, we present our outcomes in CES patients over 8 years (December 2011 – October 2019) with the aim to assess the risk of out-of-hours surgeries.
We performed a retrospective analysis of inpatient events and outcomes at 6 months follow-up. Patient demographics, symptoms and management data were extracted, and a risk factor analysis was performed using logistic regression. Outcome was represented by incidence of complications and symptom change at follow-up. Symptom outcome changes between two time-points were analysed using repeated measures.
A total of 278 patients were included in the study. Out-of-hours(p=0.018) and prolonged operations(p=0.018) were significant risk factors for intra-operative complications. Improved outcomes at six months follow-up were found for lower back pain, sciatica, altered saddle sensation and urinary sphincter disturbance, and no significant changes for the rest of the symptoms. Out-of-hours surgeries did not significantly impact individual symptom outcome.
Our analysis suggests emergency decompressive surgery for patients with cauda equina syndrome provides no worsening of outcome associated with out-of-hours operating compared to in-hours. However, it equally showed there is no clear benefit to expediting surgery for those with severe presentations. Thus, we agree that decompressive surgery should be undertaken at the earliest possible time to safely do so.

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