Related Experiment Videos
Assessing the Safety of Overlapping Surgery at a Children's Hospital
Joseph A Hyder1,2, Kristine T Hanson2, Curtis B Storlie2,3
1Department of Anesthesiology, Mayo Clinic, Rochester, MN.
Insights
Overlapping and non-overlapping pediatric surgeries showed similar safety profiles at one children's hospital. Mortality and length of stay (LOS) did not significantly differ between the two groups, suggesting comparable safety.
Area of Science:
- Pediatric Surgery
- Patient Safety
- Healthcare Quality Improvement
Background:
- Concerns exist regarding the safety of overlapping surgical procedures.
- National scrutiny necessitates single-center evaluations of overlapping surgery safety.
- Previous studies often have limited sample sizes.
Purpose of the Study:
- To compare the safety of overlapping versus non-overlapping pediatric surgical procedures.
- To evaluate inpatient mortality and length of stay (LOS) for these procedures.
- To discuss methodological considerations for evaluating surgical procedure safety.
Main Methods:
- Retrospective analysis of pediatric inpatient surgical procedures (January 2013-September 2015).
- Matching of overlapping and non-overlapping procedures using an unbalanced m:n ratio.
- Mixed models were used to compare inpatient mortality and LOS, adjusting for risk, case-mix, and surgeon.
Main Results:
- 315 overlapping procedures were matched with 645 non-overlapping procedures.
- No significant difference in adjusted odds of mortality between overlapping and non-overlapping procedures (aOR = 0.94, P = 0.98).
- Adjusted LOS estimates were not clinically different (0.6% longer for non-overlapping; P = 0.91).
Conclusions:
- The safety of overlapping and non-overlapping surgical procedures was comparable at this pediatric center.
- Findings may not be generalizable to other healthcare settings.
- Length of stay or intraoperative measures may be more suitable than mortality for safety evaluations due to low event rates.
Importance:
Media reports have questioned the safety of overlapping surgical procedures, and national scrutiny has underscored the necessity of single-center evaluations of its safety; however, sample sizes are likely small. We compared the safety profiles of overlapping and nonoverlapping pediatric procedures at a single children's hospital and discussed methodological considerations of the evaluation.
Data And Design:
Retrospective analysis of inpatient pediatric surgical procedures (January 2013 to September 2015) at a single pediatric referral center. Overlapping and nonoverlapping procedures were matched in an unbalanced manner (m:n) by procedure. Mixed models adjusting for Vizient-predicted risk, case-mix, and surgeon compared inpatient mortality and length of stay (LOS).
Results:
Among 315 overlapping procedures, 256 (81.3%) were matched to 645 nonoverlapping procedures. There were 6 deaths in all. The adjusted odds ratio for mortality did not differ significantly between nonoverlapping and overlapping procedures (adjusted odds ratio = 0.94 vs overlapping; 95% CI, 0.02-48.5; P = 0.98). Wide confidence intervals were minimally improved with Bayesian methods (95% CI, 0.07-12.5). Adjusted LOS estimates were not clinically different by overlapping status (0.6% longer for nonoverlapping; 95% CI, 9.7% shorter to 12.2% longer; P = 0.91). Among the 87 overlapping procedures with the greatest overlap (≥60 min or ≥50% of operative duration), there were no deaths.
Conclusions:
The safety of overlapping and nonoverlapping surgical procedures did not differ at this children's center. These findings may not extrapolate to other centers. LOS or intraoperative measures may be more appropriate than mortality for safety evaluations due to low event rates for mortality.