How Safe Is Overlapping Surgery?

Overlapping surgeries are efficient, but are they safe? A new study of 22,220 operations at an ambulatory surgery center tries to answer that question.

The study, “Complications Following Overlapping Orthopaedic Procedures at an Ambulatory Surgery Center,” appears inThe Journal of Bone and Joint Surgery.

In 2015, the Boston Globe’s Spotlight team reported on a case where surgery was performed by a surgeon who was engaging in the practice of overlapping surgeries and had problems as a result.

Overlapping surgery is when a single surgeon treats two (or presumably more) patients in separate operating rooms but is present for only the more skilled portions of the surgeries. Surgeons, in these overlapping cases, may nor may not be present for non-critical portions of the surgeries (skin incision, skin closure, etc). Concurrent surgery is when a single surgeon is treating two patients in two separate operating rooms simultaneously including an overlap of the critical portions of both surgeries.

How safe is this practice?

In the study, the researchers looked at 5,198 overlapping surgeries and 17,022 nonoverlapping surgeries. According to the authors, “…The median duration of surgery overlap was 8 minutes; no operations were concurrent. After weighting, the only continuous variables that differed significantly between the groups were operative time (median, 57 compared with 56 minutes for the overlapping and the nonoverlapping group, respectively), anesthesia time (median, 97 compared with 93 minutes), and total tourniquet time (median, 26 compared with 22 minutes…”

Charles A. Goldfarb, M.D., professor of Orthopedic Surgery, vice chair and chief, Pediatric and Adolescent Orthopedics, and co-chief of the Orthopedic Hand Service at Washington University in St. Louis and co-author toldOTW, “We feel that in the appropriate setting, overlapping surgery can be safe and efficient. There has been much discussion around this topic but limited specific examinations on this topic in orthopedics.”

“This paper evaluated overlapping surgery in the outpatient, surgery center setting and Chris Dy (my partner here at Washington University) also evaluated this is an inpatient setting.”

“Overlapping surgery can benefit patients (improved access) and physicians (efficiency) without compromising safety. But, the practice must be carefully considered and cases carefully planned.”