Association of Overlapping Surgery With Perioperative Outcomes
Eric Sun1,2, Michelle M Mello2,3, Chris A Rishel1
1Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California.
JAMA
|February 27, 2019
Summary
Overlapping surgery did not increase mortality or complications in most patients but did increase surgery length. High-risk patients experienced increased mortality and complications during overlapping procedures.
Area of Science:
- Surgical outcomes research
- Patient safety
- Health services research
Background:
- Overlapping surgery, where a surgeon manages multiple procedures concurrently, raises concerns regarding patient safety and potential adverse outcomes.
- Understanding the impact of overlapping surgery on mortality, complications, and procedure duration is crucial for surgical practice and patient care.
Purpose of the Study:
- To investigate the association between overlapping surgery and in-hospital mortality, postoperative complications, and surgery length.
- To identify if specific patient subgroups are at higher risk during overlapping surgical procedures.
Main Methods:
- A retrospective cohort study analyzed 66,430 operations across various surgical types (total knee/hip arthroplasty, spine surgery, CABG, craniotomy) from 2010-2018.
- Overlapping surgery was defined as at least one hour of overlap or the entire duration for cases under one hour.
- Outcomes included in-hospital mortality, major/minor complications, and surgery duration, with follow-up until discharge.
Main Results:
- Overlapping surgery (12% of cases) was not significantly associated with increased in-hospital mortality or overall complication rates compared to non-overlapping surgery.
- A significant increase in surgery length was observed for overlapping procedures (30 minutes longer).
- High-risk patients undergoing overlapping surgery showed significantly higher rates of mortality and complications compared to low-risk patients.
Conclusions:
- Overlapping surgery in adults undergoing common procedures is not linked to increased mortality or complication rates but is associated with longer surgery durations.
- The findings suggest that while overall risk may not increase, specific high-risk patient populations may experience adverse outcomes during overlapping surgeries.
- Further research is warranted to explore the nuanced associations of overlapping surgery within distinct patient subgroups.
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