Outcomes With Overlapping Surgery at a Large Academic Medical Center

Ponce, Brent A.; Wills, Bradley W.; Hudson, Parke; Huntley, Samuel; Starnes, Austin C.; Watson, Shawna L.; Rue, Loring W.; Perez, Jorge L; McGwin, Gerald

doi:10.1097/sla.0000000000002701

Cited by 27 publications

(22 citation statements)

References 27 publications

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“…These studies were performed in a number of specialties, such as neurosurgery, [10][11][12][13][14] head and neck surgery, 15,16 orthopaedic surgery, [17][18][19] pediatric surgery, 20 and general surgery. 9,[21][22][23] However, these studies did not address patient perception of what overlapping surgery is and how it affects the studied outcome.…”

Section: Discussionmentioning

confidence: 99%

Perceptions and Awareness of Overlapping Surgery in Patients With Shoulder Pain Presenting to an Orthopaedic Sports Medicine Clinic

Matar

Johnson

Shah

et al. 2020

Arthroscopy, Sports Medicine, and Rehabilitation

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Purpose To determine patients’ baseline understanding of overlapping surgery and to evaluate how education changes the perception of the practice in orthopaedic shoulder pain patients at a single institution. Methods All patients who visit the clinic with a chief complaint of shoulder pain were given a 15-question survey. The initial 15-question survey assessed demographics, pre-existing knowledge on the practice of overlapping surgery, and their perception of it. They immediately read a statement on the practice of overlapping surgery. After reading the statement, patients were re-evaluated on their level of concern. Results A total of 100 patients (55 female, 45 male) completed the survey. Mean age was 53.0 (range, 18-85) years. In total, 38 (38%) had no knowledge on the practice of overlapping surgery; 27 (27%) reported their level of concern as a 1, the lowest level of concern. Overall, 84 (84%) patients reported a level of concern of 3 (median) or lower, indicating a low level of concern. A total of 95 (95%) patients reported either a decrease or no change in level of concern after reading an educational statement on overlapping surgery practices, and 60 (60%) believed there would be no impact if an overlapping surgery was performed. If a patient reported a high level of concern, the most common reasons cited were that the attending physician may not be available during the whole case (15%); that a resident, fellow, or physician assistant may jeopardize the patient’s care (24%); or that a critical step would be missed (37%). Conclusions There is a low level of baseline understanding of overlapping surgery in patients with shoulder pain. An educational component added during patient counseling proved to be effective in decreasing the level of concern. This study suggests that counseling and education on overlapping surgery may change patient perception and opinion of the practice. Clinical Relevance Serves as an evaluation of the knowledge of a specific patient population on overlapping surgery and how it changes with counseling and education.

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Section: Discussionmentioning

confidence: 99%

Perceptions and Awareness of Overlapping Surgery in Patients With Shoulder Pain Presenting to an Orthopaedic Sports Medicine Clinic

Matar

Johnson

Shah

et al. 2020

Arthroscopy, Sports Medicine, and Rehabilitation

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“…A number of studies have examined the association of overlapping surgery with adverse events, 7,13,18,20 and although the vast majority of these have found no association between the practice and increased complication rate, a number of centers, including our own, have adjusted their policies in response to the increasing controversy. Our study represents the first analysis of costs related to overlapping surgery in a broad neurosurgical case mix and the first examining the influence of a more restrictive policy on costs.…”

Section: Discussionmentioning

confidence: 99%

“…In the years since, several studies in a variety of surgical specialties have investigated the topic, with a focus on the safety of the practice. 7,13,18,20 Although patient safety is and undoubtedly should be the primary concern of the overlapping surgery debate, some observers, including members of a US Senate Finance Committee investigation, have raised concerns regarding the cost-effectiveness of the practice as well. 21 Data on the costs related to overlapping procedures are scant, with only a single study published to date examining this association in spine surgeries.…”

mentioning

confidence: 99%

Analysis of an overlapping surgery policy change on costs in a high-volume neurosurgical department

Guan¹,

Karsy²,

Brock³

et al. 2019

Journal of Neurosurgery

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OBJECTIVEOverlapping surgery remains a controversial topic in the medical community. Although numerous studies have examined the safety profile of overlapping operations, there are few data on its financial impact. The authors assessed direct hospital costs associated with neurosurgical operations during periods before and after a more stringent overlapping surgery policy was implemented.METHODSThe authors retrospectively reviewed the records of nonemergency neurosurgical operations that took place during the periods from June 1, 2014, to October 31, 2014 (pre–policy change), and from June 1, 2016, to October 31, 2016 (post–policy change), by any of the 4 senior neurosurgeons authorized to perform overlapping cases during both periods. Cost data as well as demographic, surgical, and hospitalization-related variables were obtained from an institutional tool, the Value-Driven Outcomes database.RESULTSA total of 625 hospitalizations met inclusion criteria for cost analysis; of these, 362 occurred prior to the policy change and 263 occurred after the change. All costs were reported as a proportion of the average total hospitalization cost for the entire cohort. There was no significant difference in mean total hospital costs between the prechange and postchange period (0.994 ± 1.237 vs 1.009 ± 0.994, p = 0.873). On multivariate linear regression analysis, neither the policy change (p = 0.582) nor the use of overlapping surgery (p = 0.273) was significantly associated with higher total hospital costs.CONCLUSIONSA more restrictive overlapping surgery policy was not associated with a reduction in the direct costs of hospitalization for neurosurgical procedures.

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“…In recent years, the practice of overlapping surgeries, which consists of a main surgeon coordinating two or more operating rooms at the same time, has been the subject of extensive debates between the medical community and society, [1][2][3] besides gaining more and more space in the main journals around the world. [4][5][6][7][8] This practice, although not legally permitted in Brazil, is quite common in academic medical centers, being essential for the training of residents and presenting benefits such as reduced waiting time for patients to undergo surgery, decrease in surgical costs, optimization of hospital revenues, in addition to promoting the development of skills and autonomy of resident doctors and increasing the number of doctors involved in patient care. 3,5 Although more extensive research is needed on this topic, studies suggest that there is no increased risk and complications involving such practice.…”

Section: Introductionmentioning

confidence: 99%

“…3,9 A decrease in the rates of general complications and no impact on complications of surgical wounds was found in surgeries performed with the participation of resident doctors in orthopedics and traumatology, despite prolonged surgical times. 10 However, although some studies have addressed the impact of resident participation in surgeries and procedure outcomes, including overlapping surgeries, 8,11 few studies have investigated the patient's perception of the participation of the resident physician in their treatment. 12 Thus, the purpose of the present study is to identify the knowledge of the patients about the academic and professional training of the resident doctor in orthopedics and traumatology, as well as to evaluate the perception of these patients in relation to the care of residents in the surgical, outpatient and nursing wards environment.…”

Section: Introductionmentioning

confidence: 99%

A atuação do médico residente em ortopedia e traumatologia em um hospital de grande porte do Sistema Único de Saúde: Qual a visão do usuário?

Oliveira

Ramallo

Møller

et al. 2020

Rev Bras Ortop (Sao Paulo)

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Resumo Objetivo Avaliar o conhecimento de pacientes atendidos em um hospital-escola acerca da formação acadêmica e profissional do médico residente em ortopedia e traumatologia, bem como sua área de atuação, e determinar a percepção de conforto e segurança do paciente em relação a ser assistido pelo médico residente em diferentes etapas do tratamento. Métodos Foi realizado um estudo transversal com pacientes internados em um hospital de ortopedia de grande porte do Sistema Único de Saúde (SUS). Os dados foram coletados a partir da aplicação de um questionário contendo 19 questões objetivas que avaliaram parâmetros sociodemográficos e a percepção do paciente quanto à atuação do residente. Os dados foram analisados de forma a avaliar a frequência das respostas obtidas. Resultados Foram avaliados 152 participantes, predominantemente do sexo masculino (62,5%) e com idade entre 36 e 55 anos (41,3%). Apenas 43,3% tinham conhecimento sobre a formação acadêmica do residente. Os pacientes relataram se sentir mais seguros e confortáveis em serem assistidos pelo médico em conjunto com o residente na consulta ambulatorial (43,3%), na enfermaria (39,3%) e durante a cirurgia (61%). Quanto à atuação do residente, 80,2% afirmaram que o médico residente melhora a comunicação entre o paciente e o cirurgião principal, entretanto e apenas 11% disseram se sentir seguros e confortáveis sendo cuidados exclusivamente por residentes no ambiente cirúrgico, caso fosse permitido. Conclusão A participação de médicos residentes nos cuidados é bem recebida pelos pacientes, desde que em companhia do médico assistente. Os pacientes identificam nos residentes uma ponte facilitadora na comunicação com os médicos assistentes.

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Outcomes With Overlapping Surgery at a Large Academic Medical Center

Cited by 27 publications

References 27 publications

Perceptions and Awareness of Overlapping Surgery in Patients With Shoulder Pain Presenting to an Orthopaedic Sports Medicine Clinic

Perceptions and Awareness of Overlapping Surgery in Patients With Shoulder Pain Presenting to an Orthopaedic Sports Medicine Clinic

Analysis of an overlapping surgery policy change on costs in a high-volume neurosurgical department

A atuação do médico residente em ortopedia e traumatologia em um hospital de grande porte do Sistema Único de Saúde: Qual a visão do usuário?

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