|Overlapping surgeries seem safe, for the most part
|Two large studies have documented that overlapping surgeries are safe but a third study suggests the risk may be greater for elderly patients.
Hospital Safety Insider quotes a review of more than 2,000 neurosurgical cases published in JAMA which found no greater risk of postoperative complications for patients operated on by surgeons conducting overlapping surgeries. The study, published in November 2017, followed patients who underwent neurosurgical procedures at Emory University Hospital in Atlanta from 2014 to 2015.
Of the 2,275 cases reviewed, about 43% had the surgeon remain with the patient through the entire procedure. In the other 57% of cases, the primary surgeon performed two procedures in different operating rooms.
In the 90 days following their operations, no difference was found in morbidity, mortality, or worsened outcome measures between the two groups of patients. The researchers concluded that this data suggests overlapping neurosurgeries are safe and may benefit patients by allowing sought-after specialists to see more patients.
In another large study, Mayo Clinic researchers concluded that overlapping surgery is as safe as non-overlapping surgery and delivers similar outcomes for patients. Spacing operations so a surgeon has two patients in operating rooms at the same time is a common practice in surgery at Mayo and other leading medical institutions, according to the Mayo Clinic.
The Mayo study, published in the Annals of Surgery in April 2017, reviewed Mayo Clinic data from the Vizient Clinical Data Base/Resource Manager, which collects patient data from participating academic medical centers and community hospitals, to match 10,614 overlapping surgeries to 16,111 non-overlapping procedures performed at Mayo in Rochester.
An additional sample using more than 10,000 operations including more than 3,000 with overlap, matched by surgeon, was analyzed using data from Mayo Clinic’s Rochester campus in the American College of Surgeons-National Surgical Quality Improvement Program. That analysis also found no differences in outcomes.
“Our data shows that overlapping surgery as practiced here is safe. We think it provides value to our patients because it allows more patients timely access to surgery and care by expert teams,” said Dr. Robert Cina, chair of surgical quality at Mayo Clinic’s Rochester campus.
In overlapping surgeries, procedures are staggered so the key parts, called the “critical portions,” do not occur at the same time; the surgeon is present for the critical portions of each operation and immediately available for non-critical portions such as closing the wound.
A recent study in JAMA Internal Medicine reached different conclusions. This study, published in January 2018, reviewed 960 hip fracture cases and 1,560 hip replacement cases performed in overlapping fashion and matched them with non-overlapping cases. The results showed that overlapping surgery produced increased risk of surgical complications in a one-year period, and that longer overlap time was associated with a higher risk for complications.
Although this study is noteworthy because it followed patients for one year, while other studies looked at much-shorter time frames, the number of patients followed was much smaller than in other studies and the patients were much older (average age 84 years).
The researchers concede as much in concluding “overlapping hip fracture surgery was relatively uncommon so the results may not be generalizable to hospitals where overlapping surgical procedures are more common and not generalizable to other surgical procedures.”