Background/Objectives: The impact of surgical timing on perioperative outcomes remains a subject of ongoing debate. Although after-hours surgery has been associated with adverse outcomes in various surgical populations, its role in lumbar spine surgery remains unclear. This study aimed to evaluate factors associated with postoperative intensive care unit (ICU) admission in patients undergoing lumbar spine surgery. Methods: In this retrospective observational study, 460 patients who underwent lumbar spine surgery were analyzed. Patients were categorized according to the timing of surgery as in-hours or after-hours. Demographic, clinical, intraoperative, and laboratory parameters were compared between the two groups. Multivariable logistic regression analysis was performed to evaluate factors associated with postoperative ICU admission. Results: Of the 460 patients, 380 (82.6%) underwent surgery during in-hours and 80 (17.4%) after-hours. The baseline characteristics, including age, sex, and comorbidities, were comparable between the two groups. ICU admission was significantly more frequent in the after-hours group (45.0% vs. 19.5%, p < 0.001), whereas the length of hospital stay and intraoperative variables were similar between the two groups. Preoperative laboratory analysis revealed higher inflammatory markers (NLR and SII) and lower albumin levels in the after-hours group (all p < 0.05), whereas postoperative values were comparable. In the multivariable analysis, after-hours surgery remained independently associated with ICU admission (adjusted OR 4.82, 95% CI 2.15–10.78, p < 0.001). Lower preoperative albumin and higher preoperative NLR demonstrated borderline significance. Conclusions: After-hours lumbar spine surgery was associated with a significantly increased rate of ICU admission, even after adjustment for patient characteristics, surgical urgency, and clinical indications. These findings suggest that surgical timing may contribute to increased perioperative resource utilization and highlight the potential role of system-level and organizational factors in influencing perioperative outcomes.

Aims: Robotic-assisted surgery imposes a distinctive combination of physiological conditions that define a specific anaesthetic problem: prolonged carbon dioxide pneumoperitoneum, fixed steep head-down positioning, and restricted access to the patient after docking. Bibliometric analyses of robotic surgery have been organised by surgical specialty, and none has mapped its anaesthetic and perioperative dimension. This study describes the structure, growth and thematic evolution of that literature. Methods: The Web of Science Core Collection was searched for articles and reviews published in English between 2000 and 2025 combining robotic surgery terms with anaesthetic and perioperative terms. Retracted and duplicate records were removed and both authors independently reviewed all flagged records. Analyses were performed in R with the bibliometrix package and VOSviewer, after harmonising country names, affiliations and author keywords with purpose-built thesauri. Results: The final corpus comprised 1,528 documents from 422 journals and 8,626 authors, attracting 20,985 citations (h-index 58). Output grew at 14.6% annually between 2010 and 2025, with 55.8% of the literature published in the last five years. The United States led output (567 documents), followed by the Republic of Korea (178). Yonsei University was the most productive institution (50 documents). International collaboration was limited (11.78%). The proportion of this literature appearing in anaesthesiology journals fell from 48.5% in 2001-2008 to 21.9% in 2021-2025. Five thematic clusters emerged; telesurgery and Artificial Intelligence were present only as low-frequency emerging topics. Conclusion: This literature is expanding rapidly but is increasingly published outside anaesthesiology journals, with limited international collaboration.

Postoperative pulmonary complications remain a leading cause of morbidity after abdominal surgery. The recent study by Gültop and Şensöz Çelik offers an important contribution: combined block and intravenous (BIV) analgesia effectively preserves postoperative diaphragm contractility compared with single-modality techniques.