Association of Overlapping Surgery With Increased Risk for Complications Following Hip Surgery

Abstract

IMPORTANCE Overlapping surgery, also known as double-booking, refers to a controversial practice in which a single attending surgeon supervises 2 or more operations, in different operating rooms, at the same time. OBJECTIVE To determine if overlapping surgery is associated with greater risk for complications following surgical treatment for hip fracture and arthritis. DESIGN, SETTING, AND PARTICIPANTS This was a retrospective population-based cohort study in Ontario, Canada (population, 13.6 million), for the years 2009 to 2014. There was 1 year of follow-up. This study encompassed 2 large cohorts. The "hip fracture" cohort captured all persons older than 60 years who underwent surgery for a hip fracture during the study period. The "total hip arthroplasty" (THA) cohort captured all primary elective THA recipients for arthritis during the study period. We matched overlapping and nonoverlapping hip fractures by patient age, patient sex, surgical procedure (for the hip fracture cohort), primary surgeon, and hospital. EXPOSURES Procedures were identified as overlapping if they overlapped with another surgical procedure performed by the same primary attending surgeon by more than 30 minutes. MAIN OUTCOMES AND MEASURES Complication (infection, revision, dislocation) within 1 year. RESULTS There were 38 008 hip fractures, and of those, 960 (2.5%) were overlapping (mean age of patients, 66 years [interquartile range, 57-74 years]; 503 [52.4%] were female). There were 52 869 THAs and of those, 1560 (3.0%) overlapping (mean age, 84 years [interquartile range, 77-89 years]; 1293 [82.9%] were female). After matching, overlapping hip fracture procedures had a greater risk for a complication (hazard ratio [HR], 1.85; 95% CI, 1.27-2.71; P = .001), as did overlapping THA procedures (HR, 1.79; 95% CI, 1.02-3.14; P = .04). Among overlapping hip fracture operations, increasing duration of operative overlap was associated with increasing risk for complications (adjusted odds ratio, 1.07 per 10-minute increase in overlap; P = .009). CONCLUSIONS AND RELEVANCE Overlapping surgery was relatively rare but was associated with an increased risk for surgical complications. Furthermore, increasing duration of operative overlap was associated with an increasing risk for complications. These findings support the notion that overlapping provision of surgery should be part of the informed consent process.

Association of Duration of Surgery With Postoperative Delirium Among Patients Receiving Hip Fracture Repair

“…We excluded procedures shorter than 30 minutes or longer than 240 minutes, as these atypical cases are not representative of most hip fracture procedures. 27 …”

Epidemiologic Characteristics and Double-buffered Strategy for Patients in Orthopedic Surgery During the Novel Coronavirus Outbreak: Wuhan's Experience

“…The patients were mostly in poor physical condition and presented with a combination of various diseases, including hypertension, heart disease, and diabetes [14]. These patients were recommended for hospitalization for early surgical treatment, which can reduce various complications caused by long-term bed rest, including lung infections, urinary system infections, deep vein thrombosis, and bedsores [15,16]. In the present study, two cases who fell from a vertical height of over 3 meters presented multiple fractures.…”

Analysis of an overlapping surgery policy change on costs in a high-volume neurosurgical department

“…A number of studies have examined the association of overlapping surgery with adverse events, 7,13,18,20 and although the vast majority of these have found no association between the practice and increased complication rate, a number of centers, including our own, have adjusted their policies in response to the increasing controversy. Our study represents the first analysis of costs related to overlapping surgery in a broad neurosurgical case mix and the first examining the influence of a more restrictive policy on costs.…”

“…In the years since, several studies in a variety of surgical specialties have investigated the topic, with a focus on the safety of the practice. 7,13,18,20 Although patient safety is and undoubtedly should be the primary concern of the overlapping surgery debate, some observers, including members of a US Senate Finance Committee investigation, have raised concerns regarding the cost-effectiveness of the practice as well. 21 Data on the costs related to overlapping procedures are scant, with only a single study published to date examining this association in spine surgeries.…”