The surgeon will see you now…and you too. New research performed at the Departments of Orthopaedic Surgery and Epidemiology and Biostatistics at the University of California at San Francisco (UCSF) looks into the practice of a surgeon performing procedures in two operating rooms during overlapping time frames.
Overlapping Surgery in an Outpatient Orthopedic Setting
1 min read Premium comments
Secondary
According to the study, published November 16, 2016 in The Journal of Bone and Joint Surgery, if the procedures occur in two operating rooms and involve vital stages happening concurrently, then this is known as “concurrent surgery.” If critical portions do not occur simultaneously, it is known as “overlapping surgery.” This retrospective review is the first study in orthopedic surgery to investigate the outcomes of overlapping procedures.
Thomas Vail, M.D., a co-author on the study, told OTW: “The subject of this work is of primary interest at this time given the focus on value in healthcare. In orthopaedics, we are trying hard to achieve the highest quality and safety, while at the same time using resources such as the operating room efficiently. Our look at the outpatient practice at UCSF allows us to evaluate the practice of using staggered starts in the operating room so that the surgeon and the operating staff minimize down time between cases, focusing instead on the actual performance of the surgical procedure. We thought it would be worthwhile publishing our experience, noting that we have found that this organizational strategy has been very effectively with our model of care. There may be variability in other settings, or locations where protocols are different. We plan to perform the same quality review for our inpatient surgery.”
According to the article, the researchers found that out of 3, 640 cases performed, 68% were overlapping procedures and 32% were non-overlapping. As for overlapping cases, 50% overlapped by 2 hours. The rate of complications was found to have no association with the amount of overlap between cases.
“Overlapping surgery yields equivalent patient operating room time, procedure time, and 30-day complication rates as non-overlapping surgery in the ambulatory orthopaedic setting, ” say the authors.
React:
Discussion
This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
Join the conversation
Orthopedic professionals are discussing this. Sign in and upgrade to read every comment and add your voice.