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Sataloff RT, Ranjbar PA, Balouch B, Barna A, Al Omari AI, Martha V, Alnouri G. Overlapping otolaryngologic surgery: Safety and efficacy. Am J Otolaryngol 2024; 45:104292. [PMID: 38640813 DOI: 10.1016/j.amjoto.2024.104292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 04/14/2024] [Indexed: 04/21/2024]
Abstract
BACKGROUND Surgical procedures scheduled staggered between two operating rooms increase efficiency by eliminating turnover time. However, the practice might increase the surgeon's fatigue. Overlapping surgery has been assumed to be safe because no critical portions of procedures are performed simultaneously in two rooms, but there is little evidence in the literature to support that assumption for otolaryngologic surgery, and there is no evidence comparing non-overlapping and overlapping surgical outcomes for a single surgeon with all confounding factors controlled. METHODS Retrospective cohort study that included a consecutive sample of adult subjects who underwent otolaryngologic laryngeal or otologic surgery between June 2013 and March 2016. All procedures were performed by the same surgical team and surgeon who had block time with 2-rooms every other week and 1-room on alternate weeks. The incidence of surgical complications was assessed in the perioperative period. Duration of surgery and time-in-room also were evaluated, as were surgical outcomes. RESULTS A total of 496 surgeries were assigned to either overlapping-surgery (n = 346) or non-overlapping-surgery (n = 150) cohorts. Overlapping-surgery was a significant predictor for increased time-in-room on multivariate analysis but was not a significant predictor for surgery duration. Rate of complications, hospital readmission, emergency department visit, reoperation, mortality, and patient satisfaction did not differ significantly between cohorts. CONCLUSIONS Overlapping surgery does not hinder patient safety or functional outcomes in patients undergoing otolaryngologic operations such as voice or ear surgery.
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Affiliation(s)
- Robert T Sataloff
- Department of Otolaryngology - Head and Neck Surgery, Senior Associate Dean for Clinical Academic Specialties, Drexel University College of Medicine, Philadelphia, PA, United States.
| | - Parastou Azadeh Ranjbar
- Department of Otolaryngology - Head and Neck Surgery, Tulane University, New Orleans, LA, United States
| | - Bailey Balouch
- Division of Otolaryngology - Head and Neck Surgery, Cooper University Health Care, Camden NJ, Cooper Medical School of Rowan University, Camden, NJ, United States
| | - Alexander Barna
- Medical Student, Drexel University College of Medicine, United States
| | - Ahmad Issa Al Omari
- Department of Otolaryngology - Head and Neck Surgery, UPMC Memorial Hospital, York, PA, United States; Department of Special Surgery, Jordan University of Science and Technology, Irbid, Jordan
| | - Vishnu Martha
- Department of Otolaryngology-Head & Neck Surgery, Malla Reddy Institute of Medical Sciences, Hyderabad, Telangana, India; Department of Otolaryngology - Head and Neck Surgery, Drexel University College of Medicine, United States
| | - Ghiath Alnouri
- Department of Otolaryngology - Head and Neck Surgery, Ohio University Heritage Collage of Osteopathic Medicine, Athens, OH, United States
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Ahmed M, Suhrawardy A, Olszewski A, Rahman T, Makhni EC. Overlapping Surgery in Orthopaedics: A Review of Efficacy, Surgical Costs, Surgical Outcomes, and Patient Safety. J Am Acad Orthop Surg 2024; 32:75-82. [PMID: 37738639 DOI: 10.5435/jaaos-d-23-00069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 07/26/2023] [Indexed: 09/24/2023] Open
Abstract
INTRODUCTION Overlapping surgery (OS) refers to when an attending surgeon supervises two surgeries at the same time with noncritical portions of both surgeries occurring simultaneously. Limited literature reviewing OS exists in orthopaedics. Our goal is to provide insight into this practice across orthopaedic subspecialities to inform its future utilization. METHODS A review of the literature was conducted after Preferred Reporting Items for Systematic Reviews and Meta-Analyses systematic review guidelines. All articles (630 total) were independently reviewed by two authors with a third to resolve discrepancies. Inclusion criteria encompassed any journal publication that included data on a series of orthopaedic OS. Data points sought included the type of surgery, quantity of cases, case duration, overlap time, perioperative complications, and cost. RESULTS Eleven articles met the inclusion criteria, encompassing a total of 34,494 overlapping surgeries. The studies varied regarding setting and subspecialties included. Six studies demonstrated increased surgical times for overlap cases. Two studies found that although OS increased cost per case, it improved the overall efficiency. Ten studies tracked short-term outcomes (<90 days) and reported no increase in complications with OS. Only one study examined long-term outcomes (1 year) and found a markedly increased risk for surgical complications with OS, with higher complication rates among nonelective compared with elective cases. DISCUSSION Current literature suggests that OS may increase surgical time, but from the 11 articles reviewed, only one demonstrates an increase in perioperative complications across orthopaedic subspecialities. OS also seems to increase costs per case; however, this is offset by the ability to perform more cases in the same period, resulting in an overall increase in the net profit. These data are consistent with studies from other surgical specialties. CONCLUSION Although OS seems to be both safe and effective, future investigations are needed to understand the impact it has on patients and healthcare systems.
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Affiliation(s)
- Muhammad Ahmed
- From the Wayne State University School of Medicine, Detroit, MI (Ahmed and Olszewski), the Oakland University William Beaumont School of Medicine, Auburn Hills, MI (Suhrawardy), and the Department of Orthopedic Surgery, Henry Ford Health, Detroit, MI (Rahman and Makhni)
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Liu Y, Chen S, Hammack-Aviran CM, Drolet BC, Perdikis G. Overlapping Surgeries From the Patient's Perspective. J Surg Res 2023; 286:85-95. [PMID: 36803878 DOI: 10.1016/j.jss.2022.10.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 09/11/2022] [Accepted: 10/16/2022] [Indexed: 02/17/2023]
Abstract
INTRODUCTION Overlapping surgery (OS) occurs when a single surgeon is concurrently caring for patients in multiple operating rooms (OR) but is present for all critical portions of each surgery. Although this is common practice, most studies have found public disapproval of OS. This study aims to better understand attitudes toward OS of patients who gave informed consent for OS. METHODS Participant interviews covered topics including trust, OR personnel roles, and attitudes toward OS. Four representative transcripts were distributed among researchers for independent code identification. These were aggregated into a codebook, applied by two coders. Iterative and emergent thematic analyses were done. RESULTS Twelve participants were interviewed to reach thematic saturation. Three themes shaped how participants felt about OS: trust in their surgeon, worries about OS, and understanding of OR personnel roles. Factors contributing to trust included personal research and the surgeon's experience. Frequently cited concerns were unpredictability of complications during operations and the surgeon's divided attention. Two participants inaccurately understood personnel roles, believing the surgeon did most or all the hands-on work while trainees were observers. Most participants felt a high or neutral level of comfort toward OS and indicated trust as the reason. CONCLUSIONS In contrast to prior research, this study found that most participants had a neutral or positive view of OS. This suggests that a trusting relationship with their surgeon and informed consent are important factors in increasing comfort for OS. Participants who misunderstood OR roles felt less comfortable toward OS. This highlights an opportunity for patient education on trainee roles.
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Affiliation(s)
- Yangzi Liu
- Vanderbilt University School of Medicine, Nashville, Tennessee.
| | - Shirley Chen
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | | | - Brian C Drolet
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, Tennessee; Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Galen Perdikis
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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Pitts CC, Ponce BA, Arguello AM, Willis JG, McGwin G, Vatsia S, Parks CT, Wills BW. Impact of the Percentage of Overlapping Surgery on Patient Outcomes: A Retrospective Cohort Study of 87,000 Surgical Cases. Ann Surg 2023; 277:756-760. [PMID: 36538641 DOI: 10.1097/sla.0000000000005739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES The primary objective of this study was to analyze the relationship of percentage of surgical overlap with patient outcomes to determine if a detrimental level of overlap exists. BACKGROUND Overlapping surgery is defined as 1 attending physician supervising 2 or more operative cases simultaneously, without the critical portions of the cases occurring concurrently. To date, no study has examined the relationship of percent overlap, or the percentage of 1 case that is spent overlapping with another, to outcomes, efficiency, safety, and complications. METHODS This study is a retrospective cohort study conducted at a large tertiary referral center. The primary outcomes of interest included operative duration, in-hospital mortality, 30-day readmission, and patient safety indicators (PSIs). The Cochran-Armitage test for trend was used to evaluate the outcomes of interest. P values of ≤0.05 were considered statistically significant. RESULTS A total of 87,426 cases were included in this study. There were 62,332 cases without overlap (Group 0), 10,514 cases with 1% to 25% overlap (Group 1), 5303 cases with 26% to 50% overlap (Group 2), 4296 cases with 51% to 75% overlap (Group 3), and 4981 cases with >75% overlap (Group 4). In-hospital mortality decreased as overlap increased ( Ptrend <0.0001). Operative time increased with increasing overlap ( Ptrend <0.0001) while readmission rates showed no statistical significance between groups ( Ptrend =0.5078). Rates of PSIs were lower for Groups 1, 2, and 3 (1.69%, 2.01%, and 2.08%) when compared to Group 0 (2.24%). Group 4 had the highest rate of PSIs at 2.35% ( P =0.0086). CONCLUSION Overlapping surgery was shown to have reduced in-hospital mortality and similar PSI and readmission rates when compared to nonoverlapping cases. Operative time was shown to increase in overlapping surgeries when compared to nonoverlapping surgeries. The results from this study indicate that the percentage of surgical overlap does not detrimentally affect most patient outcomes, especially with overlap of <75%.
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Affiliation(s)
- Charles C Pitts
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, AL
| | - Brent A Ponce
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, AL
- Department of Orthopaedic Surgery, Hughston Clinic, Columbus, GA
| | - Alexandra M Arguello
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, AL
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN
| | - Joseph G Willis
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, AL
| | - Gerald McGwin
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, AL
| | - Sohrab Vatsia
- Department of Orthopaedic Surgery, Hughston Clinic, Columbus, GA
| | - Chris T Parks
- Department of Orthopaedic Surgery, The Orthopaedic Center, Huntsville, AL
| | - Brad W Wills
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, AL
- Department of Orthopaedic Surgery, The Orthopaedic Center, Huntsville, AL
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Outcomes and Patient Safety in Overlapping vs. Nonoverlapping Total Joint Arthroplasty: A Systematic Review and Meta-Analysis. J Am Acad Orthop Surg 2021; 29:e1387-e1395. [PMID: 34874337 DOI: 10.5435/jaaos-d-20-01130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 04/24/2021] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Overlapping surgery is defined as two cases occurring in separate operating rooms (ORs), where the same attending surgeon conducts the critical surgical portions of each case at different times. Although it has been suggested that this established practice may improve the utilization of resources, allow for more opportunities to teach surgical trainees, and facilitate timely access to care, there is still no consensus on its use in elective orthopaedic surgery, such as total joint arthroplasty (TJA). METHODS A systematic review and meta-analysis of the literature was done according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify articles investigating the use of overlapping and single operating room TJA. Relevant data, including surgical time, intraoperative complications, postoperative complications, mortality rate, revision rate, and readmission rate, were extracted and recorded. RESULTS Six articles were included (35,938 patients: 17,677 overlapping and 18,261 nonoverlapping). Overall revision rates were 1.2% and 1.1% for the overlapping and nonoverlapping cohorts, respectively (odds ratio [OR] = 1.19; 95% confidence interval [CI]: 0.93 to 1.53). The overall intraoperative complication rate was 1.6% for both cohorts (OR = 0.98; 95% CI: 0.79 to 1.23), and the overall postoperative orthopaedic complication rates were 2.0% and 1.95% within the overlapping and nonoverlapping OR cohorts, respectively (OR = 1.07; 95% CI: 0.89 to 1.29). The readmission rate was 4.6% in the overlapping group and 4.2% in the nonoverlapping group (OR = 0.88; 95% CI: 0.70 to 1.11). Two studies with comparable groups reported markedly increased surgical time in the overlapping group compared with the nonoverlapping group. DISCUSSION Overlapping surgery was found to be as safe as nonoverlapping surgery in patients undergoing TJA. Although overlapping TJA surgery is associated with satisfactory short-term revision rates, prolonged follow-up is required to further assess the medium-term and long-term outcomes of overlapping surgery compared with nonoverlapping surgery. Finally, although overlapping TJA surgery might be associated with increased OR time, this difference is not clinically relevant.
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Allahabadi S, Wu HH, Allahabadi S, Woolridge T, Kohn MA, Diab M. Concurrent and overlapping surgery: perspectives from surgeons on spinal posterior instrumented fusion for adolescent idiopathic scoliosis. J Child Orthop 2021; 15:589-595. [PMID: 34987670 PMCID: PMC8670537 DOI: 10.1302/1863-2548.15.210142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 11/05/2021] [Indexed: 02/03/2023] Open
Abstract
PURPOSE The purpose of this study was to determine perspectives of surgeons regarding simultaneous surgery in patients undergoing posterior spine instrumentation and fusion (PSIF) for adolescent idiopathic scoliosis (AIS). METHODS A survey was administered to orthopaedic trainees and faculty regarding simultaneous surgery for primary PSIF for AIS. A five-point Likert scale (1: 'Strongly Disagree' to 5: 'Strongly Agree') was used to assess agreement with statements about simultaneous surgery. We divided simultaneous surgery into concurrent, when critical portions of operations occur at the same time, and overlapping, when noncritical portions occur at the same time. RESULTS The 72 respondents (78.3% of 92 surveyed) disagreed with concurrent surgery for 'one of my patients' (response mean 1.76 (sd 1.03)) but were more accepting of overlapping surgery (mean 3.94 (sd 0.99); p < 0.0001). The rating difference between concurrent and overlapping surgery was smaller for paediatric and spine surgeons (-1.25) than for residents or those who did not identify a subspecialty (-2.17; p = 0.0246) or other subspecialty surgeons (-2.57; p = 0.0026). Respondents were more likely to agree with explicit informed consent for concurrent surgery compared with overlapping (mean 4.32 (sd 0.91) versus 3.44 (sd 1.14); p < 0.001). CONCLUSION Orthopaedic surgeons disagreed with concurrent but were more accepting of overlapping surgery and anaesthesia for PSIF for AIS. Respondents were in greater agreement that patients should be explicitly informed of concurrence than of overlap. The surgical community's evidence and position regarding simultaneous surgery, in particular overlapping, must be more effectively presented to the public in order to bridge the gap in perspectives. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Sachin Allahabadi
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California, United States
| | - Hao-Hua Wu
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California, United States
| | - Sameer Allahabadi
- School of Medicine, Texas Christian University and University of North Texas Health Science Center, Fort Worth, Texas, United States
| | - Tiana Woolridge
- Department of Pediatrics, University of California San Francisco, San Francisco, California, United States
| | - Michael A. Kohn
- Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California, United States
| | - Mohammad Diab
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California, United States,Correspondence should be sent to Mohammad Diab, MD, 1825 Fourth Street, San Francisco, CA 94158, United States. E-mail:
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Perez AW, Brelsford KM, Diehl CJ, Langerman AJ. Surgeon Perspectives on Benefits and Downsides of Overlapping Surgery: In-depth, Qualitative Interviews. Ann Surg 2021; 274:e403-e409. [PMID: 32282374 DOI: 10.1097/sla.0000000000003722] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE The aim of the study was to characterize surgeon perspectives regarding the benefits and downsides of conducting overlapping surgery. BACKGROUND Although surgeons are key stakeholders in current discussions surrounding overlapping surgery, little has been published regarding their opinions on the practice. Further characterization of surgeon perspectives is needed to guide future studies and policy development regarding overlapping surgery. METHODS Study information was sent to all members of 3 professional surgical societies. Interested individuals were eligible to participate if they identified as attending surgeons in an academic setting who work with trainees. Purposive selection was used to diversify surgeons interviewed across multiple dimensions, including subspecialty and opinion regarding appropriateness of overlapping surgery. In-depth, qualitative interviews were conducted with participants regarding their opinions on overlapping surgery. RESULTS The 51 surgeons interviewed identified a wide array of potential benefits and disadvantages of overlapping surgery, some of which have not previously been measured, including downsides to surgeon wellness and patient experience, less surgeon control over procedures, and difficulty in scheduling cases. Interviewees often disagreed as to whether overlapping surgery negatively or positively affects each dimension discussed, particularly regarding the impact on resident training. CONCLUSIONS The utilization of the novel perspectives presented here will allow for targeted assessment of physician perspectives in future quantitative studies and increase the likelihood that variables measured encompass the range of factors that surgeons find meaningful and relevant. Priority areas of future research should include examining effects of overlapping surgery on surgical training and surgeon wellness.
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Affiliation(s)
| | - Kathleen M Brelsford
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, TN
| | - Carolyn J Diehl
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, TN
| | - Alexander J Langerman
- Program in Surgical Ethics, Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, TN
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, TN
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Guyton GP. Standards for Noninferiority Trials in Orthopaedic Surgery Would Be Arbitrary: It's Time We Had Some. J Bone Joint Surg Am 2021; 103:e69. [PMID: 33793436 DOI: 10.2106/jbjs.20.01949] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Gregory P Guyton
- Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, Maryland
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Pereira D, Lee DH. CORR Synthesis: What Is the Current Understanding of Overlapping Surgery in Orthopaedics, Particularly as it Relates to Patient Outcomes and Perceptions? Clin Orthop Relat Res 2021; 479:1208-1216. [PMID: 33239517 PMCID: PMC8133144 DOI: 10.1097/corr.0000000000001584] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 11/03/2020] [Indexed: 01/31/2023]
Affiliation(s)
- Daniel Pereira
- D. Pereira, D. H. Lee, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
- D. H. Lee, Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Donald H Lee
- D. Pereira, D. H. Lee, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
- D. H. Lee, Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Mitchell MB, Hammack-Aviran CM, Clayton EW, Langerman A. A Survey of Overlapping Surgery Policies at U.S. Hospitals. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2021; 49:64-73. [PMID: 33966659 DOI: 10.1017/jme.2021.11] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The authors surveyed hospitals across the country on their policies regarding overlapping surgery, and found large variation between hospitals in how this practice is regulated. Specifically, institutions chose to define "critical portions" in a variety of ways, ultimately affecting not only surgical efficiency but also the autonomy of surgical trainees and patient experiences at these different hospitals.
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Abstract
OBJECTIVE To determine whether the practice of overlapping surgery influenced patient safety after open reduction internal fixation (ORIF) for ankle fractures. DESIGN Retrospective case-control. SETTING Level 1 Academic Midwest trauma center. PATIENTS All patients who underwent ankle fracture ORIF by a single surgeon were eligible for our study, with 478 total patients. INTERVENTION Cases that were overlapping were compared against cases that were not overlapping. Cases were defined as overlapping if there was greater than 30 minutes of overlap between procedural times. Patient complications were recorded up to a year from the index surgery. MAIN OUTCOME MEASURE Unexpected return to surgery. RESULTS There were 478 ankle fracture ORIF patients, 238 with at least 3 months follow-up; 124 (52%) in the overlapping group and 114 (48%) in the nonoverlapping group. There was no difference in the rate of unexpected return to surgery (P = 0.76), infection (P = 0.52), readmission (P = 0.96), painful implant (P = 0.62), malunion (P = 0.27), nonunion (P = 0.52), or arthritis (P = 0.39) between the overlapping and nonoverlapping groups. There were 467 isolated ankle fractures used for time analysis. Average procedure time was 26 minutes longer for the overlapping group than the nonoverlapping group (P < 0.01). CONCLUSIONS Overlapping surgery causes increased operative time for ankle ORIF, but there was no apparent increased risk to the patients for short-term complications. The need for graduated resident responsibility required by ACGME guidelines need to be weighed against the decreased efficiency of operating room time. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Waly FJ, Garbuz DS, Greidanus NV, Duncan CP, Masri BA. Safety of a ‘swing room’ surgery model at a high-volume hip and knee arthroplasty centre. Bone Joint J 2020; 102-B:112-115. [DOI: 10.1302/0301-620x.102b7.bjj-2019-1536.r1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims The practice of overlapping surgery has been increasing in the delivery of orthopaedic surgery, aiming to provide efficient, high-quality care. However, there are concerns about the safety of this practice. The purpose of this study was to examine the safety and efficacy of a model of partially overlapping surgery that we termed ‘swing room’ in the practice of primary total hip (THA) and knee arthroplasty (TKA). Methods A retrospective review of prospectively collected data was carried out on patients who underwent primary THA and TKA between 2006 and 2017 in two academic centres. Cases were stratified as partially overlapping (swing room), in which the surgeon is in one operating room (OR) while the next patient is being prepared in another, or nonoverlapping surgery. The demographic details of the patients which were collected included operating time, length of stay (LOS), postoperative complications within six weeks of the procedure, unplanned hospital readmissions, and unplanned reoperations. Fisher's exact, Wilcoxon rank-sum tests, chi-squared tests, and logistic regression analysis were used for statistical analysis. Results A total of 12,225 cases performed at our institution were included in the study, of which 10,596 (86.6%) were partially overlapping (swing room) and 1,629 (13.3%) were nonoverlapping. There was no significant difference in the mean age, sex, body mass index (BMI), side, and LOS between the two groups. The mean operating time was significantly shorter in the swing room group (58.2 minutes) compared with the nonoverlapping group (62.8 minutes; p < 0.001). There was no significant difference in the rates of complications, readmission and reoperations (p = 0.801 and p = 0.300, respectively) after adjusting for baseline American Society of Anesthesiologists scores. Conclusion The new ‘swing room’ model yields similar short-term outcomes without an increase in complication rates compared with routine single OR surgery in patients undergoing primary THA or TKA. Cite this article: Bone Joint J 2020;102-B(7 Supple B):112–115.
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Affiliation(s)
- Feras J. Waly
- Department of Surgery, Division of Orthopaedics, University of Tabuk, Saudi Arabia
| | - Donald S. Garbuz
- Department of Orthopaedics, University of British Columbia, Vancouver, Canada
| | - Nelson V. Greidanus
- Department of Orthopaedics, University of British Columbia, Vancouver, Canada
| | - Clive P. Duncan
- Department of Orthopaedics, University of British Columbia, Vancouver, Canada
| | - Bassam A. Masri
- Department of Orthopaedics, University of British Columbia, Vancouver, Canada
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Glauser G, Osiemo B, Goodrich S, McClintock SD, Weber KL, Levin LS, Malhotra NR. Assessment of Short-Term Patient Outcomes Following Overlapping Orthopaedic Surgery at a Large Academic Medical Center. J Bone Joint Surg Am 2020; 102:654-663. [PMID: 32058352 DOI: 10.2106/jbjs.19.00554] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Overlapping surgery is a long-standing practice that has not been well studied. The aim of this study was to assess whether overlapping surgery is associated with untoward outcomes for orthopaedic patients. METHODS Coarsened exact matching was used to assess the impact of overlap on outcomes among elective orthopaedic surgical interventions (n = 18,316) over 2 years (2014 and 2015) at 1 health-care system. Overlap was categorized as any overlap, and subcategories of exclusively beginning overlap and exclusively end overlap. Study subjects were matched on the Charlson comorbidity index score, duration of surgery, surgical costs, body mass index, length of stay, payer, and race, among others. Serious unanticipated events were studied. RESULTS A total of 3,395 patients had any overlap and were matched (a match rate of 90.8% of 3,738). For beginning and end overlap, matched groups were created, with a match rate of 95.2% of 1043 and 94.7% of 863, respectively. Among matched patients, any overlap did not predict an unanticipated return to surgery at 30 days (8.2% for any overlap and 8.3% for no overlap; p = 0.922) or 90 days (14.1% and 14.1%, respectively; p = 1.000). Patients who had surgery with any overlap demonstrated no difference compared with controls with respect to reoperation, readmission, or emergency room (ER) visits at 30 or 90 days (a reoperation rate of 3.1% and 3.2%, respectively [p = 0.884] at 30 days and 4.2% and 3.5% [p = 0.173] at 90 days; a readmission rate of 10.3% and 11.0% [p = 0.352] at 30 days and 5.5% and 5.2% [p = 0.570] at 90 days; and an ER visit rate of 5.2% and 4.6% [p = 0.276] at 30 days and 4.8% and 4.3% [p = 0.304] at 90 days). Patients with surgical overlap showed reduced mortality compared with controls during follow-up (1.8% and 2.6%, respectively; p = 0.029). Patients with beginning and/or end overlap had a similar lack of association with serious unanticipated events; however, patients with end overlap showed an increased unexpected rate of return to the operating room after reoperation at 90 days (13.3% versus 9.7%; p = 0.015). CONCLUSIONS Nonconcurrent overlapping surgery was not associated with adverse outcomes in a large, matched orthopaedic surgery population across 1 academic health system. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Gregory Glauser
- Departments of Neurosurgery (G.G. and N.R.M.) and Orthopedic Surgery (K.L.W. and L.S.L.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Benjamin Osiemo
- McKenna EpiLog Program in Population Health, University of Pennsylvania, Philadelphia, Pennsylvania.,The West Chester Statistical Institute and Department of Mathematics, West Chester University, West Chester, Pennsylvania
| | - Stephen Goodrich
- McKenna EpiLog Program in Population Health, University of Pennsylvania, Philadelphia, Pennsylvania.,The West Chester Statistical Institute and Department of Mathematics, West Chester University, West Chester, Pennsylvania
| | - Scott D McClintock
- The West Chester Statistical Institute and Department of Mathematics, West Chester University, West Chester, Pennsylvania
| | - Kristy L Weber
- Departments of Neurosurgery (G.G. and N.R.M.) and Orthopedic Surgery (K.L.W. and L.S.L.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - L Scott Levin
- Departments of Neurosurgery (G.G. and N.R.M.) and Orthopedic Surgery (K.L.W. and L.S.L.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Neil R Malhotra
- Departments of Neurosurgery (G.G. and N.R.M.) and Orthopedic Surgery (K.L.W. and L.S.L.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Murphy WS, Harris S, Pahalyants V, Zaki MM, Lin B, Cheng T, Talmo C, Murphy SB. Alternating operating theatre utilization is not associated with differences in clinical or economic outcome measures in primary elective knee arthroplasty. Bone Joint J 2019; 101-B:1081-1086. [DOI: 10.1302/0301-620x.101b9.bjj-2018-1485.r1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims The practice of alternating operating theatres has long been used to reduce surgeon idle time between cases. However, concerns have been raised as to the safety of this practice. We assessed the payments and outcomes of total knee arthroplasty (TKA) performed during overlapping and nonoverlapping days, also comparing the total number of the surgeon’s cases and the total time spent in the operating theatre per day. Materials and Methods A retrospective analysis was performed on the Centers for Medicare & Medicaid Services (CMS) Limited Data Set (LDS) on all primary elective TKAs performed at the New England Baptist Hospital between January 2013 and June 2016. Using theatre records, episodes were categorized into days where a surgeon performed overlapping and nonoverlapping lists. Clinical outcomes, economic outcomes, and demographic factors were calculated. A regression model controlling for the patient-specific factors was used to compare groups. Total orthopaedic cases and aggregate time spent operating (time between skin incision and closure) were also compared. Results A total of 3633 TKAs were performed (1782 on nonoverlapping days; 1851 on overlapping days). There were no differences between the two groups for length of inpatient stay, payments, mortality, emergency room visits, or readmission during the 90-day postoperative period. The overlapping group had 0.74 fewer skilled nursing days (95% confidence interval (CI) -0.26 to -1.22; p < 0.01), and 0.66 more home health visits (95% CI 0.14 to 1.18; p = 0.01) than the nonoverlapping group. On overlapping days, surgeons performed more cases per day (5.01 vs 3.76; p < 0.001) and spent more time operating (484.55 minutes vs 357.17 minutes; p < 0.001) than on nonoverlapping days. Conclusion The study shows that the practice of alternating operating theatres for TKA has no adverse effect on the clinical outcome or economic utilization variables measured. Furthermore, there is opportunity to increase productivity with alternating theatres as surgeons with overlapping cases perform more cases and spend more time operating per day. Cite this article: Bone Joint J 2019;101-B:1081–1086.
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Affiliation(s)
- William S. Murphy
- Harvard Medical School, Boston, Massachusetts, USA
- Harvard Business School, Boston, Massachusetts, USA
| | - Samantha Harris
- Harvard Medical School, Boston, Massachusetts, USA
- Harvard Business School, Boston, Massachusetts, USA
| | - Vartan Pahalyants
- Harvard Medical School, Boston, Massachusetts, USA
- Harvard Business School, Boston, Massachusetts, USA
| | - Mark M. Zaki
- Harvard Medical School, Boston, Massachusetts, USA
- Harvard Business School, Boston, Massachusetts, USA
| | - Ben Lin
- Archway Health, Watertown, Massachusetts, USA
| | - Tony Cheng
- Archway Health, Watertown, Massachusetts, USA
| | - Carl Talmo
- New England Baptist Hospital, Boston, Massachusetts, USA
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15
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On Patient Safety: Differential Standards for Medical Evidence Risks Patient Safety. Clin Orthop Relat Res 2019; 477:698-699. [PMID: 30844833 PMCID: PMC6437358 DOI: 10.1097/corr.0000000000000692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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