Overlapping Surgery—Perspectives From the Other Side of the Table

Zhang, Alan L.

doi:10.1001/jamainternmed.2017.6846

Cited by 4 publications

(8 citation statements)

References 5 publications

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“…That definition should be determined by an independent body of clinicians familiar with the operating room environment and monitoring to ensure that the attending surgeon is in the operating room during that time. 3 Author Affiliation: Deputy Editor, JAMA.…”

Section: Role Of the Funder/sponsor: The Nationalmentioning

confidence: 99%

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Association of Overlapping Surgery With Perioperative Outcomes

Sun

Mello

Rishel

et al. 2019

JAMA

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; for the Multicenter Perioperative Outcomes Group (MPOG) IMPORTANCE Overlapping surgery, in which more than 1 procedure performed by the same primary surgeon is scheduled so the start time of one procedure overlaps with the end time of another, is of concern because of potential adverse outcomes. OBJECTIVE To determine the association between overlapping surgery and mortality, complications, and length of surgery. DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort study of 66 430 operations in patients aged 18 to 90 years undergoing total knee or hip arthroplasty; spine surgery; coronary artery bypass graft (CABG) surgery; and craniotomy at 8 centers between January 1, 2010, and May 31, 2018. Patients were followed up until discharge. EXPOSURES Overlapping surgery (Ն2 operations performed by the same surgeon in which Ն1 hour of 1 case, or the entire case for those <1 hour, occurs when another procedure is being performed). MAIN OUTCOMES AND MEASURES Primary outcomes were in-hospital mortality or complications (major: thromboembolic event, pneumonia, sepsis, stroke, or myocardial infarction; minor: urinary tract or surgical site infection) and surgery duration. RESULTS The final sample consisted of 66 430 operations (mean patient age, 59 [SD, 15] years; 31 915 women [48%]), of which 8224 (12%) were overlapping. After adjusting for confounders, overlapping surgery was not associated with a significant difference in in-hospital mortality (1.9% overlapping vs 1.6% nonoverlapping; difference, 0.3% [95% CI, −0.2% to 0.7%]; P = .21) or risk of complications (12.8% overlapping vs 11.8% nonoverlapping; difference, 0.9% [95% CI, −0.1% to 1.9%]; P = .08). Overlapping surgery was associated with increased surgery length (204 vs 173 minutes; difference, 30 minutes [95% CI, 24 to 37 minutes]; P < .001). Overlapping surgery was significantly associated with increased mortality and increased complications among patients having a high preoperative predicted risk for mortality and complications, compared with low-risk patients (mortality: 5.8% vs 4.7%; difference, 1.2% [95% CI, 0.1% to 2.2%]; P = .03; complications: 29.2% vs 27.0%; difference, 2.3% [95% CI, 0.3% to 4.3%]; P = .03). CONCLUSIONS AND RELEVANCE Among adults undergoing common operations, overlapping surgery was not significantly associated with differences in in-hospital mortality or postoperative complication rates but was significantly associated with increased surgery length. Further research is needed to understand the association of overlapping surgery with these outcomes among specific patient subgroups.

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Section: Role Of the Funder/sponsor: The Nationalmentioning

confidence: 99%

“…A related concept, concurrent surgery, refers to situations in which the critical parts of operations occur during the same time. [1][2][3] There is concern that overlapping surgery may be associated with adverse patient outcomes. [3][4][5] For example, surgeons may less effectively address complications because they are absent at a crucial time.…”

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confidence: 99%

Association of Overlapping Surgery With Perioperative Outcomes

Sun

Mello

Rishel

et al. 2019

JAMA

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“…There has been a vigorous debate with conflicting opinions on the use of CS/OS from multiple angles. [1][2][3][4][5][6][7][8][9] OS has been a common surgical practice for 75+ years, particularly in the surgical specialties in which the noncritical parts of opening and closing can routinely last for hours (e.g., complex spinal deformity surgery, free flap plastic surgery, and transplant surgery). Traditionally, OS has been accepted without much concern within the surgical community.…”

mentioning

confidence: 99%

What Does it Mean for a Surgeon to “Run Two Rooms”? A Comprehensive Literature Review of Overlapping and Concurrent Surgery Policies

Theriault

Pazniokas

Mittal

et al. 2019

The American Surgeon

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The aim of this study was to review and analyze all of the “concurrent surgery” (CS) and “overlapping surgery” (OS) literature with the goal of: standardizing terminology, defining discrepancies in the literature and proposing solutions for the current challenges of regulating surgery to achieve maximal safety and efficiency. The CS and OS literature has grown exponentially over the past two years. Before this, there were no significant publications addressing this topic. There is an extremely wide variance on how “running two rooms” is defined and whether it should be permitted. These differences affect our patients’ perception of this practice. The literature lacks any comprehensive review of the topic and terminology. We performed a PubMed search to identify studies that considered the issue of OS. The terms “overlapping surgery”, “concurrent surgery”, and “simultaneous surgery” (SS) were used in the query. We then analyzed the publications identified. The literature contained 18 published studies analyzing OS safety between November 2016 and June 2018. Eight were neurosurgical studies, three were orthopedic, and the remaining seven articles were in other surgical specialties. A total of 1,207,155 surgical cases (range 250–>500,000 patients) were analyzed among the 18 studies. There were 57,880 (5.04%) OS cases. The OS rates in the individual studies ranged from 1.2 to 68 per cent (Table 1). Neurosurgical studies had the highest average OS rate of 54 per cent (range 37–68%), whereas the average OS rate in orthopedic surgery was 43 per cent (range 2.7–68%). Approximately one-third of the studies were multicenter investigations (27.7%). The studies measured more than 20 distinct outcomes, but there were only five outcomes that were included in the majority of the studies: mortality rates, reoperation rates, procedure length of time, readmission rates, and hospital length of stay. The current body of literature repeatedly demonstrates that OS is a safe and effective option when undertaken by experienced surgeons who practice it frequently. For successful OS, the Mandatory Attending Portion for two surgeries must not overlap and Unnecessary Anesthesia Time must be prohibited. Hospitals and surgical specialty organizations must implement policies to assure the safe practice of OS.

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“…There are profound ethical, financial, and safety considerations to consider, with the primary concern being that overlapping surgery may be associated with adverse patient outcomes. [1][2][3] Most studies to date have found no adverse association between overlapping surgery and patient outcomes. However, there are limited studies within the otolaryngology literature without good objective measures to shape policy or to address the practice.…”

mentioning

confidence: 99%

mentioning

confidence: 99%

Outcomes of Overlapping Surgery in Otolaryngology

Sioshansi

Jackler

Damrose

2019

Otolaryngol.--head neck surg.

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Objective To compare outcomes in otolaryngology between overlapping and nonoverlapping surgeries. Study Design Retrospective cohort study. Setting Tertiary referral center. Subjects and Methods All patients undergoing otolaryngologic procedures at Stanford University Hospital between January 2009 and June 2016 were included (n = 13,479). Cases were divided into 2 cohorts: overlapping (n = 1806, 13.4%) vs nonoverlapping (n = 11,673, 86.6%). Variables reviewed were type of operation performed, multidisciplinary team involvement, complications, reoperations, readmissions, and deaths. Results The total complication rate over 7.5 years studied was 3.3% (n = 450). Complication rates were lower for overlapping cases (0.77%) compared to nonoverlapping cases (3.73%) with an odds ratio of 0.2014, which was statistically significant ( P < .0001). When examined by subspecialty, the complication rate for rhinology and endoscopic skull base procedures was approximately 10 times lower when overlapping (0.30%) was compared to nonoverlapping (3.15%), with an odds ratio of 0.094 ( P = .0001). There was no difference in complication rates for other surgical subspecialties. There were no deaths associated with overlapping surgery. The rate of major complications requiring reoperation was similarly lower for overlapping procedures (0.276%) compared to nonoverlapping procedures (1.35%) with an odds ratio of 0.2023 ( P = .0004). Readmission rates were lower for overlapping cases (0.49%) when compared to nonoverlapping cases (1.09%), with an odds ratio of 0.4553 ( P = .0229). Conclusions Patients undergoing overlapping surgery had lower overall complication rates, lower reoperation rates, lower readmission rates, and no mortalities. The institutional experience presented provides evidence that with appropriate patient and case selection, otolaryngologists may safely perform overlapping surgery without increased risk of adverse patient outcomes.

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Overlapping Surgery—Perspectives From the Other Side of the Table

Cited by 4 publications

References 5 publications

Association of Overlapping Surgery With Perioperative Outcomes

Association of Overlapping Surgery With Perioperative Outcomes

What Does it Mean for a Surgeon to “Run Two Rooms”? A Comprehensive Literature Review of Overlapping and Concurrent Surgery Policies

Outcomes of Overlapping Surgery in Otolaryngology

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