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Overlapping Surgery in the Ambulatory Orthopaedic Setting.

Alan L Zhang1, David C Sing2, Debbie Y Dang2

  • 1Departments of Orthopaedic Surgery (A.L.Z., D.C.S., D.Y.D., C.B.M., T.P.V., and B.T.F.) and Epidemiology and Biostatistics (D.B.), University of California at San Francisco, San Francisco, California Alan.Zhang@ucsf.edu.

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Summary

Overlapping surgery in ambulatory orthopaedics shows no difference in patient outcomes compared to non-overlapping procedures. This study found similar complication rates, procedure times, and operating room times for both surgical approaches.

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Area of Science:

  • Orthopaedic Surgery
  • Surgical Outcomes Research
  • Patient Safety

Background:

  • Overlapping surgery, where a surgeon works in two operating rooms during the same period, has raised concerns.
  • Previous research has not investigated the outcomes of overlapping procedures specifically within orthopaedic surgery.

Purpose of the Study:

  • To investigate the outcomes of overlapping surgical procedures in an ambulatory orthopaedic setting.
  • To compare complication rates, procedure times, and operating room times between overlapping and non-overlapping surgeries.

Main Methods:

  • Retrospective review of 3,640 orthopaedic cases (sports medicine, hand, foot and ankle) from 2012-2015.
  • Collected data on patient demographics, procedure types, operating room and procedure times, and 30-day outcomes.
  • Analyzed overlap duration and used statistical tests (Pearson chi-square, Student t tests, logistic regression).

Main Results:

  • 68% of cases were overlapping; no demographic differences between overlapping and non-overlapping groups.
  • No significant differences in mean procedure time (70.7 vs 72.8 min) or total operating room time (105.4 vs 105.5 min).
  • Similar 30-day complication rates (1.1% overlapping vs 1.3% non-overlapping) with no association to overlap duration.

Conclusions:

  • Overlapping surgery in the ambulatory orthopaedic setting is associated with equivalent patient operating room time, procedure time, and 30-day complication rates compared to non-overlapping surgery.
  • Further research is recommended for inpatient orthopaedic procedures and across all subspecialties.