Overlapping Surgery in the Ambulatory Orthopaedic Setting

Zhang, Alan L.; Sing, David C.; Dang, Debbie Y; Benjamin, C.; Black, Dennis M.; Vail, Thomas P.; Feeley, Brian T.

doi:10.2106/jbjs.16.00248

Cited by 61 publications

(81 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Zhang et al 9 performed a retrospective review of a single institution over a 3-year period, and compared the rates of complications at 30 days in multiple outpatient procedures. 9 However, they did not perform any risk adjustment for procedure, or by patient and physician factors. Hyder et al 8 looked at multiple surgical procedures at a single center, using an m:n matching strategy in which all overlapping procedures of a particular type of surgery were matched to all nonoverlapping procedures of the same type of surgery, with subsequent adjustment for the individual surgeon.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

See 1 more Smart Citation

Association of Overlapping Surgery With Increased Risk for Complications Following Hip Surgery

et al. 2018

View full text Add to dashboard Cite

IMPORTANCE Overlapping surgery, also known as double-booking, refers to a controversial practice in which a single attending surgeon supervises 2 or more operations, in different operating rooms, at the same time. OBJECTIVE To determine if overlapping surgery is associated with greater risk for complications following surgical treatment for hip fracture and arthritis. DESIGN, SETTING, AND PARTICIPANTS This was a retrospective population-based cohort study in Ontario, Canada (population, 13.6 million), for the years 2009 to 2014. There was 1 year of follow-up. This study encompassed 2 large cohorts. The "hip fracture" cohort captured all persons older than 60 years who underwent surgery for a hip fracture during the study period. The "total hip arthroplasty" (THA) cohort captured all primary elective THA recipients for arthritis during the study period. We matched overlapping and nonoverlapping hip fractures by patient age, patient sex, surgical procedure (for the hip fracture cohort), primary surgeon, and hospital. EXPOSURES Procedures were identified as overlapping if they overlapped with another surgical procedure performed by the same primary attending surgeon by more than 30 minutes. MAIN OUTCOMES AND MEASURES Complication (infection, revision, dislocation) within 1 year. RESULTS There were 38 008 hip fractures, and of those, 960 (2.5%) were overlapping (mean age of patients, 66 years [interquartile range, 57-74 years]; 503 [52.4%] were female). There were 52 869 THAs and of those, 1560 (3.0%) overlapping (mean age, 84 years [interquartile range, 77-89 years]; 1293 [82.9%] were female). After matching, overlapping hip fracture procedures had a greater risk for a complication (hazard ratio [HR], 1.85; 95% CI, 1.27-2.71; P = .001), as did overlapping THA procedures (HR, 1.79; 95% CI, 1.02-3.14; P = .04). Among overlapping hip fracture operations, increasing duration of operative overlap was associated with increasing risk for complications (adjusted odds ratio, 1.07 per 10-minute increase in overlap; P = .009). CONCLUSIONS AND RELEVANCE Overlapping surgery was relatively rare but was associated with an increased risk for surgical complications. Furthermore, increasing duration of operative overlap was associated with an increasing risk for complications. These findings support the notion that overlapping provision of surgery should be part of the informed consent process.

show abstract

Section: Strengths and Limitationsmentioning

confidence: 99%

“…7 The American College of Surgeons (ACS) released guidelines around concurrent and overlapping surgery. 6 While 2 recently published peer-reviewed studies 8,9 have suggested that overlapping surgery is a safe practice, they both have significant limitations that limit their generalizability.…”

mentioning

confidence: 99%

Association of Overlapping Surgery With Increased Risk for Complications Following Hip Surgery

et al. 2018

View full text Add to dashboard Cite

show abstract

“…In the past year, several studies have suggested that, within the appropriate framework, overlapping surgery may be performed safely without an increase in intraoperative or early postoperative complications. 7,9,15,16 It is perhaps unsurprising then that our study found no difference in complication rates between overlapping and nonoverlapping cases, either overall or in the subset of serious complications, before or after a more restrictive overlapping surgery policy was implemented.…”

Section: Discussionmentioning

confidence: 57%

Impact of a more restrictive overlapping surgery policy: an analysis of pre- and postimplementation complication rates, resident involvement, and surgical wait times at a high-volume neurosurgical department

Guan¹,

Karsy²,

Brock³

et al. 2018

Journal of Neurosurgery

View full text Add to dashboard Cite

OBJECTIVE Recently, overlapping surgery has been a source of controversy both in the popular press and within the academic medical community. There have been no studies examining the possible effects of more stringent overlapping surgery restrictions. At the authors' institution, a new policy was implemented that restricts attending surgeons from starting a second case until all critical portions of the first case that could require the attending surgeon's involvement are completed. The authors examined the impact of this policy on complication rates, neurosurgical resident education, and wait times for neurosurgical procedures. METHODS The authors performed a retrospective chart review of nonemergency neurosurgical procedures performed over two 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 4 senior neurosurgeons at a single institution who were authorized to schedule overlapping cases. Information on preoperative evaluation, patient demographics, premorbid conditions, surgical variables, and postoperative course were collected and analyzed. RESULTS Six hundred fifty-three patients met inclusion criteria for complications analysis. Of these, 378 (57.9%) underwent surgery before the policy change. On multivariable regression analysis, neither overlapping surgery (odds ratio [OR] 1.072, 95% confidence interval [CI] 0.710-1.620) nor the overlapping surgery policy change (OR 1.057, 95% CI 0.700-1.596) was associated with overall complication rates. Similarly, neither overlapping surgery (OR 1.472, 95% CI 0.883-2.454) nor the overlapping surgery policy change (OR 1.251, 95% CI 0.748-2.091) was associated with numbers of serious complications. After the policy change, the percentage of procedures in which the senior assistant was a postresidency fellow increased significantly, from 11.9% to 34.2% (p< 0.001). In a multiple linear regression analysis of surgery wait times, patients undergoing surgery after the policy change had significantly longer delays from the decision to operate until the actual neurosurgical procedure (p < 0.001). CONCLUSIONS At the authors' institution, further restriction of overlapping surgery was not associated with a reduction in overall or serious complications. Resident involvement in neurosurgical procedures decreased significantly after the policy change, and this study suggests that wait times for neurosurgical procedures also significantly lengthened.

show abstract

“…In 2015, this concept gained wide attention after an expos e was published by the Boston Globe Spotlight Team regarding potential risks and lack of patient awareness of the practice 1 ; soon thereafter, publications regarding overlapping surgery followed from orthopedic and other surgeons, some focusing on its controversy and ethics. [2][3][4][5] Overlapping surgery is described as the practice of the primary responsible surgeon participating in another operation after critical portions of the first operation are completed; typically, this is done with the understanding that there is no need for the primary responsible surgeon to return to the first operation. Usually, the primary responsible surgeon is defined as the surgeon who performs all critical parts of the procedure and is always available to return the operating room if needed.…”

mentioning

confidence: 99%

Commentary: Risk of overlapping surgery in cardiac surgery? Much ado about nothing

Dolapoglu

Coselli

2021

The Journal of Thoracic and Cardiovascular Surgery

View full text Add to dashboard Cite

Overlapping Surgery in the Ambulatory Orthopaedic Setting

Cited by 61 publications

References 15 publications

Association of Overlapping Surgery With Increased Risk for Complications Following Hip Surgery

Association of Overlapping Surgery With Increased Risk for Complications Following Hip Surgery

Impact of a more restrictive overlapping surgery policy: an analysis of pre- and postimplementation complication rates, resident involvement, and surgical wait times at a high-volume neurosurgical department

Commentary: Risk of overlapping surgery in cardiac surgery? Much ado about nothing

Contact Info

Product

Resources

About