The Practice of Overlapping Surgery Is Safe in Total Knee and Hip Arthroplasty

Abstract

Background:Overlapping surgery occurs when a surgeon performs 2 procedures in an overlapping time frame. This practice is commonplace in the setting of total joint arthroplasty and is intended to increase patient access to experienced surgeons, improve efficiency, and advance the surgical competence of surgeons and trainees. The practice of overlapping surgery has been questioned because of safety and ethical concerns. As the literature is scarce on this issue, we evaluated the unplanned hospital readmission and reoperation rates associated with overlapping and non-overlapping total joint arthroplasty procedures.Methods:We reviewed 3,290 consecutive primary total knee and hip arthroplasty procedures that had been performed between November 2010 and July 2016 by 2 fellowship-trained senior surgeons at a single institution. Overlapping surgery was defined as the practice in which the attending surgeon performed a separate procedure in another room with an overlapping room time of at least 30 minutes. Patient baseline characteristics and 90-day rates of complications, readmissions, and reoperations were compared between overlapping and non-overlapping procedures. Subanalyses also were done on patients with a body mass index (BMI) of ≥30 kg/m2 and those with an American Society of Anesthesiologists (ASA) score of 3 or 4. The level of significance was set at 0.05.Results:Of the 2,833 procedures that met the inclusion criteria, 57% (1,610) were overlapping and 43% (1,223) were non-overlapping. Baseline demographics, BMI, and ASA scores were similar between the groups. No significant differences were found between the overlapping and non-overlapping procedures in terms of the 90-day rates of complications (5.2% vs. 6.6%, respectively; p = 0.104), unplanned readmissions (3.4% vs. 4.3%; p = 0.235), or reoperations (3.1 vs. 3.1; p = 1.0) in the analysis of the entire cohort or in subgroup analyses of obese patients and patients with an ASA score of 3 or 4. The total mean operating room time was 5.8 minutes higher for overlapping procedures.Conclusions:Overlapping procedures showed no increase in terms of the 90-day rates of complications, readmissions, or reoperations when compared with non-overlapping procedures. There was just over a 5-minute increase in mean operating room time for overlapping procedures. Our data suggest that overlapping surgery does not lead to detrimental outcomes following total knee arthroplasty or total hip arthroplasty. Future investigations evaluating patient-oriented outcomes and satisfaction are warranted.Level of Evidence:Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Outcomes and Patient Safety in Overlapping vs. Nonoverlapping Total Joint Arthroplasty: A Systematic Review and Meta-Analysis

“…Exclusion criteria consisted of (1) case reports or series with ,10 patients, (2) review articles, (3) expert opinions, (4) letters to editors, (5) instructional course lectures, (6) studies involving animals or cadavers or in vitro investigations, (7) book chapters, (8) abstracts from scientific meetings, (9) unpublished reports, (10) studies in which no subjects underwent TJA, (11) studies which analyzed different surgeries in conjunction with TJA, (12) studies that did not include TJAs done in an overlapping surgery setting and (nonoverlapping surgery) setting for direct comparison, and (13) non-English language publications. A cross-reference search of the selected articles was also done to obtain other relevant articles.…”

“…Four studies defined overlapping surgery as a TJA surgery that was preceded or followed by another joint replacement procedure (primary or revision) in a different OR, with a scheduled time overlap of at least 30 minutes between the cases. 9,[11][12][13] One of these studies reported that the interquartile range for the overlap time was between 60 and 104 minutes. 11 One study defined overlapping surgery as that in which the surgeon completed the critical portions of a case and then transitioned directly to a second room for the critical portions of the next procedure.…”

“…One defined it as the initial incision through the completion of implant cementing, 10 whereas another study defined it as soft-tissue balancing, trialing, and cementing of the implant in total knee arthroplasties (TKAs) and femoral neck osteotomy, acetabular reaming, cup impaction, trialing, and stem insertion in total hip arthroplasties (THAs). 12 (see Table, Supplemental Digital Content 2, http://links. lww.com/JAAOS/A639, which illustrates the results of each study).…”

“…11 The other study reported a statistically significant difference in age, with the overlapping group being slightly older (mean difference = 0.81 years; P , 0.001). 9 Finally, three studies reported the number of THAs and TKAs in the overlapping and nonoverlapping cohorts, 11,12,14 with two studies indicating more TKAs done in the overlapping group. 11,14 Revisions Revision rates were reported by four of the six studies (see Table , Supplemental Digital Content 2, http://links.lww.…”

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?

“…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.…”