Managing overlapping surgery: an analysis of 1018 neurosurgical and spine cases

Abstract

OBJECTIVE Overlapping surgery-the performance of parts of 2 or more surgical procedures at the same time by a single lead surgeon-has recently come under intense scrutiny, although data on the effects of overlapping procedures on patient outcomes are lacking. The authors examined the impact of overlapping surgery on complication rates in neurosurgical patients. METHODS The authors conducted a retrospective review of consecutive nonemergent neurosurgical procedures performed during the period from May 12, 2014, to May 12, 2015, by any of 5 senior neurosurgeons at a single institution who were authorized to schedule overlapping cases. Overlapping surgery was defined as any case in which 2 patients under the care of a single lead surgeon were under anesthesia at the same time for any duration. Information on patient demographics, premorbid conditions, surgical variables, and postoperative course were collected and analyzed. Primary outcome was the occurrence of any complication from the beginning of surgery to 30 days after discharge. A secondary outcome was the occurrence of a serious complication-defined as a life-threatening or life-ending event-during this same period. RESULTS One thousand eighteen patients met the inclusion criteria for the study. Of these patients, 475 (46.7%) underwent overlapping surgery. Two hundred seventy-one patients (26.6%) experienced 1 or more complications, with 134 (13.2%) suffering a serious complication. Fourteen patients in the cohort died, a rate of 1.4%. The overall complication rate was not significantly higher for overlapping cases than for nonoverlapping cases (26.3% vs 26.9%, p = 0.837), nor was the rate of serious complications (14.7% vs 11.8%, p = 0.168). After adjustments for surgery type, surgery duration, body mass index, American Society of Anesthesiologists (ASA) physical classification grade, and intraoperative blood loss, overlapping surgery remained unassociated with overall complications (OR 0.810, 95% CI 0.592-1.109, p = 0.189). Similarly, after adjustments for surgery type, surgery duration, body mass index, ASA grade, and neurological comorbidity, there was no association between overlapping surgery and serious complications (OR 0.979, 95% CI 0.661-1.449, p = 0.915). CONCLUSIONS In this cohort, patients undergoing overlapping surgery did not have an increased risk for overall complications or serious complications. Although this finding suggests that overlapping surgery can be performed safely within the appropriate framework, further investigation is needed in other specialties and at other institutions.

Association of Overlapping Surgery With Patient Outcomes in a Large Series of Neurosurgical Cases

“…These data are generally consistent with previous reports. 13,15 A commonly cited concern is that OS may lead to increased anesthesia and operative time for patients, which, in turn, may lead to complications, such as respiratory failure and wound infections. 1,9,10,12,15 Both OS-R and OS-StS cases were significantly longer than NOS cases in this study.…”

Analysis of overlapping surgery in patients undergoing microsurgical aneurysm clipping: acute and long-term outcomes from the Barrow Ruptured Aneurysm Trial

“…In teaching institutions, overlapping cases are also associated with more resident involvement and graduated autonomy for surgeons in training, which many believe represents an invaluable learning opportunity. 4,9,23 However, recent reports questioning the safety of overlapping surgery have required surgeons and institutions to address this strategy to ensure that the best possible care is being offered to patients. 16,21 Few studies have been performed on this subject to date, and recent changes in practice have been driven by anecdotal reports of surgical complications in overlapping or concurrent cases.…”

“…1,21 Concerns about patient safety have led to nationwide changes in surgical scheduling regulations; however, limited data examining this practice exist. No studies published to date have found any evidence of worse outcomes with overlapping surgery; 5,9,11,23 however, these studies examined heterogeneous populations of patients undergoing a variety of neurosurgical procedures.…”

Accuracy in Deep Brain Stimulation Electrode Placement: A Single-Surgeon Retrospective Analysis of Sterotactic Error in Overlapping and Non-Overlapping Surgical Cases

“…Ultimately, as other authors have noted [3], the safety and effectiveness of overlapping surgeries are undoubtedly variable across procedures and institutions, and further study will be necessary to elucidate when this practice is appropriate. The definition of the “critical portion of the case” is subject to debate.…”