Overlapping surgery in arthroplasty - a systematic review and meta-analysis

Area of Science:

• Orthopaedic Surgery
• Patient Safety
• Healthcare Management

Background:

• Planned overlapping surgery (OS) in elective total hip arthroplasty (THA) and total knee arthroplasty (TKA) offers potential benefits like improved efficiency and reduced costs.
• However, patient safety concerns have led to scrutiny of OS practices.
• This systematic review and meta-analysis aimed to compare postoperative outcomes, length of stay, and surgery duration between non-overlapping surgery (NOS) and OS for THA and TKA.

Approach:

• A systematic literature search was conducted across major databases (MEDLINE, PubMed, Embase, Cochrane).
• Included studies were published in English and assessed for risk of bias using ROBINS-I and GRADE frameworks.
• Relative risk and mean difference with 95% confidence intervals were used for analysis, with an alpha level of 0.05.

Key Points:

• Nine studies encompassing 120,625 patients were analyzed.
• No statistically significant differences were found in overall postoperative complications, dislocations, fractures, infections, readmissions, or revision surgery rates between NOS and OS.
• Length of stay and surgery duration also showed no significant differences between the two surgical scheduling methods.

Conclusions:

• Elective orthopaedic THA and TKA performed with overlapping surgery do not result in increased postoperative adverse outcomes compared to non-overlapping surgery.
• OS in elective lower limb arthroplasty appears safe when coupled with appropriate patient selection.
• This scheduling method can be a valuable tool for improving hospital efficiency, provided informed consent and preoperative patient education are prioritized.