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Overlapping surgery for ankle fractures increased operative time but did not elevate patient complication risks. This finding highlights a trade-off between resident training needs and operating room efficiency.

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Area of Science:

  • Orthopedic surgery
  • Patient safety research

Background:

  • Overlapping surgery, where a surgeon manages multiple procedures concurrently, is a practice that raises concerns regarding patient safety and healthcare efficiency.
  • The Accreditation Council for Graduate Medical Education (ACGME) mandates graduated resident responsibility, which can contribute to surgical overlap.
  • The impact of overlapping surgery on patient outcomes after specific orthopedic procedures, such as open reduction internal fixation (ORIF) for ankle fractures, requires thorough investigation.

Purpose of the Study:

  • To investigate the association between overlapping surgery and patient safety following open reduction internal fixation (ORIF) for ankle fractures.
  • To compare complication rates and surgical outcomes between overlapping and non-overlapping surgical cases.

Main Methods:

  • Retrospective case-control study conducted at a Level 1 Academic Midwest trauma center.
  • Analysis of 478 patients who underwent ankle fracture ORIF by a single surgeon.
  • Cases were defined as overlapping if there was >30 minutes of procedural overlap; complications were tracked for up to one year.

Main Results:

  • No significant differences in unexpected return to surgery, infection, readmission, painful implant, malunion, nonunion, or arthritis rates were observed between overlapping and non-overlapping groups.
  • Average procedure time was significantly longer by 26 minutes in the overlapping surgery group (P < 0.01).
  • The study included 238 patients with at least 3 months of follow-up, with 124 in the overlapping group and 114 in the non-overlapping group.

Conclusions:

  • Overlapping surgery for ankle fracture ORIF leads to increased operative time but does not appear to increase short-term patient complication risks.
  • The benefits of graduated resident training must be balanced against the potential decrease in operating room efficiency associated with overlapping procedures.
  • Further research may be warranted to explore long-term outcomes and optimize surgical scheduling practices.