Overlapping Surgery Increases Operating Room Efficiency Without Adversely Affecting Outcomes in Total Hip and Knee Arthroplasty

Zachwieja, Erik; Yayac, Michael; Wills, Bradley W.; Wilt, Zachary; Austin, Matthew S.; Courtney, P. Maxwell

doi:10.1016/j.arth.2020.01.062

Cited by 14 publications

(36 citation statements)

References 24 publications

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“…Yet, Zachwieja et al. [35], championing overlapping models in hip and knee surgery (one of the specialties highlighted by Sun et al. [40] as carrying a higher risk of complications with overlapping), concluded that the mean total number of cases a surgeon could perform in an 8‐h block increased by just one case (i.e.…”

Section: Observational and Trial Evidence Of Overlapping Surgerymentioning

confidence: 99%

“…For overlapping surgery to prove better than conventional scheduling, it needs to demonstrate significantly >2x cases completed. Yet, Zachwieja et al [35], championing overlapping models in hip and knee surgery (one of the specialties highlighted by Sun et al [40] as carrying a higher risk of complications with overlapping), concluded that the mean total number of cases a surgeon could perform in an 8-h block increased by just one case (i.e. the gain in cases was just x + 1; not 2x).…”

Section: Productivity and Costs Savingsmentioning

confidence: 99%

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The effect of overlapping surgical scheduling on operating theatre productivity: a narrative review

2022

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Summary This article reviews the background to overlapping surgery, in which a single senior surgeon operates across two parallel operating theatres; anaesthesia is induced and surgery commenced by junior surgeons in the second operating theatre while the lead surgeon completes the operation in the first. We assess whether there is any theoretical basis to expect increased productivity in terms of number of operations completed. A review of observational studies found that while there is a perception of increased surgical output for one surgeon, there is no evidence of increased productivity compared with two surgeons working in parallel. There is potential for overlapping surgery to have some positive impact in situations where turnover times between cases are long, operations are short (<2 h) and where ‘critical portions’ of surgery constitute about half of the total operation time. However, any advantages must be balanced against safety, ethical and training concerns.

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Section: Observational and Trial Evidence Of Overlapping Surgerymentioning

confidence: 99%

Section: Productivity and Costs Savingsmentioning

confidence: 99%

The effect of overlapping surgical scheduling on operating theatre productivity: a narrative review

2022

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“…In a study of 18 316 elective orthopaedic procedures (3395 overlapping), Glauser et al 3 found no difference in reoperation, readmission or emergency room visit rates at 30 or 90 days compared with matched controls. In a cohort of 4786 primary THA/TKA patients undergoing simultaneous surgeries of at least 30 minutes, Zachwieja et al 5 found no difference in readmission rate, length of stay or rates of discharge. Similarly, Zhang et al 7 found no difference in rate of complications, mean procedure time, mean operating room time or overall complications in 3640 elective surgeries at a single ambulatory centre.…”

Section: Discussionmentioning

confidence: 97%

“…Support for simultaneous surgery includes that it increases supply to meet demand for patients, and that it increases efficiency for hospitals and surgeons. Zachwieja et al 5 found that there was an increased profit margin of $1215 per procedure for primary total hip arthroplasty (THA) and total knee arthroplasty (TKA) when cases overlapped by at least 30 minutes. This conflict of interest, in addition to the theoretical risk of adverse events, has called simultaneous surgery into question.…”

Section: Discussionmentioning

confidence: 99%

Concurrent and Overlapping Surgery: Perspectives from Surgeons on Spinal Posterior Instrumented Fusion for Adolescent Idiopathic Scoliosis

Allahabadi

et al. 2021

Journal of Children's Orthopaedics

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Purpose The purpose of this study was to determine perspectives of surgeons regarding simultaneous surgery in patients undergoing posterior spine instrumentation and fusion (PSIF) for adolescent idiopathic scoliosis (AIS). Methods A survey was administered to orthopaedic trainees and faculty regarding simultaneous surgery for primary PSIF for AIS. A five-point Likert scale (1: ‘Strongly Disagree’ to 5: ‘Strongly Agree’) was used to assess agreement with statements about simultaneous surgery. We divided simultaneous surgery into concurrent, when critical portions of operations occur at the same time, and overlapping, when noncritical portions occur at the same time. Results The 72 respondents (78.3% of 92 surveyed) disagreed with concurrent surgery for ‘one of my patients’ (response mean 1.76 (sd 1.03)) but were more accepting of overlapping surgery (mean 3.94 (sd 0.99); p < 0.0001). The rating difference between concurrent and overlapping surgery was smaller for paediatric and spine surgeons (-1.25) than for residents or those who did not identify a subspecialty (-2.17; p = 0.0246) or other subspecialty surgeons (-2.57; p = 0.0026). Respondents were more likely to agree with explicit informed consent for concurrent surgery compared with overlapping (mean 4.32 (sd 0.91) versus 3.44 (sd 1.14); p < 0.001). Conclusion Orthopaedic surgeons disagreed with concurrent but were more accepting of overlapping surgery and anaesthesia for PSIF for AIS. Respondents were in greater agreement that patients should be explicitly informed of concurrence than of overlap. The surgical community’s evidence and position regarding simultaneous surgery, in particular overlapping, must be more effectively presented to the public in order to bridge the gap in perspectives. Level of Evidence IV

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“…In the orthopaedic OR, Lean methodology has demonstrated a 55% reduction in instruments from 792 to 433 in 11 of 102 instrument trays, with a weight reduction of over 574 pounds (22% lower) 25 . Another methodology for increasing surgeon efficiency during TKA is overlapping ORs 26 . Although personnel costs and surgical times were increased slightly ($80 and 8.3 minutes, respectively), the number of cases a surgeon could perform during an 8 hour period was increased by 1.2, which translated to an increased per case profit margin of $1215.…”

Section: Comparative Approaches For or Efficiencymentioning

confidence: 99%

The Use of Customized Total Knee Arthroplasty Implants to Increase Efficiency in the Operating Room and Improve Patient Outc

Sinha

2021

MRAJ

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Operating room efficiency during surgical procedures saves time and money, reduces waste of hospital resources and improves staff morale. Surgical efficiency in orthopaedic surgery can decrease medical complications, such as periprosthetic infection and venous thromboembolic disease, but also must be associated with equivalent or improved longer term patient reported outcomes. In total knee arthroplasty, the instruments used for bone preparation are excessive in number, are frequently redundant, and rely upon achieving average alignment and rotational parameters. As a result, approximately 15-25% of patients report dissatisfaction with their knee reconstructions. Patient specific customized instruments and patient specific implants improve intraoperative efficiency by reducing surgical steps and eliminating redundant steps. Further, because the customized instruments and implants provide anatomic reconstruction of each individual patient, patient reported outcomes have been higher. Additional demonstrated benefits include improved knee alignment and knee kinematics. This paper addresses the various sources of operating room inefficiency, provides suggestions to overcome them, and discusses the first decade of experience with the customized guides for customized implants as a method to improve efficiency.

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Overlapping Surgery Increases Operating Room Efficiency Without Adversely Affecting Outcomes in Total Hip and Knee Arthroplasty

Cited by 14 publications

References 24 publications

The effect of overlapping surgical scheduling on operating theatre productivity: a narrative review

The effect of overlapping surgical scheduling on operating theatre productivity: a narrative review

Concurrent and Overlapping Surgery: Perspectives from Surgeons on Spinal Posterior Instrumented Fusion for Adolescent Idiopathic Scoliosis

The Use of Customized Total Knee Arthroplasty Implants to Increase Efficiency in the Operating Room and Improve Patient Outc

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