A new study published online on December 4, 2017 in JAMA Internal Medicine investigated the association between overlapping surgeries (i.e., double-booked surgeries, where a single attending surgeon supervises two or more surgeries occurring in different operating rooms at the same time) for hip fractures and end-stage arthritis, and found that overlapping surgeries increased the risk for complications following surgery, particularly for nonelective surgeries. The primary complications the researchers analyzed were the occurrence of an infection, revision, or dislocation within one year.
The researchers found that there was an approximately ninety percent (90%) increase in the risk for surgical complications at one year for patients undergoing overlapping surgical procedures (the association was reportedly weaker for elective hip replacement surgeries than in hip fractures).
The researchers analyzed 38,008 hip fracture surgeries at more than 75 hospitals in Canada, of which 960, or 2.5%, were overlapping procedures. The researchers also analyzed 52,869 primary elective total hip arthroplasties, of which 1,560, or 3.0%, were overlapping procedures. Not only did the researchers find after matching that overlapping hip fracture surgeries and overlapping total hip arthroplasties had a greater risk for a complication, but they also found that among overlapping hip fracture surgeries, increasing the duration of the operative overlap was associated with increasing risk for complications.
The study’s key findings were: “approximately 2.5% of patients with hip fracture and 3.0% of THA recipients [total hip arthroplasties] were operated on by a surgeon who was also performing another operation. After matching, patients undergoing overlapping hip fracture repairs had a significantly increased risk for surgical complications (an increase from 6.4% to 10.4%). This risk worsened as the duration of overlap increased, with every additional 10 minutes of overlap raising the risk for a complication by approximately 7.0%. Overlapping THA procedures were also at increased risk; however, the relationship was not as pronounced (an increase from 1.4% to 2.3%).”
“Overlapping procedures were at increased risk for the occurrence of a complication, particularly infection and early revision. The most likely mechanism for increased risk arises from having less experienced surgeons or surgical trainees perform portions of the case.”
“These findings further suggest that overlapping surgery may be safer when performed in the context of an elective procedure, when the surgeon and the rest of the health care team can adequately prepare to deliver care in an overlapping fashion.”
The study’s authors concluded: “Most important, our findings reinforce the notion that overlapping provision of surgery must be part of the informed consent process.”
Overlapping surgeries require that the attending surgeons be present for critical parts of the procedures and that they be readily available at other times during the surgeries, as needed. The stated justifications for allowing overlapping surgeries are to improve hospital resource utilization, to provide opportunities to educate surgical trainees, and to promote timely access to care, especially for emergency cases.
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