Study: Overlapping Surgery Not a Problem (Mainly)

Overlapping surgery occurs when a single surgeon operates on more than one patient at the same time. This approach has been controversial. Typically, in cases of overlapping surgeries, the orthopedic surgeon is present for the critical portions of each patient’s operation but is not present for the entirety of the case—leaving it to other, less senior members of the team, to finish.

How safe is overlapping surgery? A team of researchers from the University of Pennsylvania and West Chester University addressed that question in a study titled, “Assessment of Short-Term Patient Outcomes Following Overlapping Orthopaedic Surgery at a Large Academic Medical Center.” This work appears in the April 15, 2020 edition of The Journal of Bone and Joint Surgery.

Co-author Neil Mahotra, M.D., vice chairman for Operations in the Department of Neurosurgery and associate program director of the Department of Neurological Surgery at the University of Pennsylvania explained to OTW that commentary in the lay press led to their inquiry…and that the issue of overlapping orthopedic surgery has not been well-studied.

Dr. Mahotra and his colleagues reviewed data from 18,316 surgeries over two years (2014 and 2015) at the University of Pennsylvania. The authors wrote, “Overlap was categorized as any overlap, and subcategories of exclusively beginning overlap and exclusively ending 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.”

A total of 3,395 patients had any overlap, with overlap not predicting an unanticipated return to surgery at 30 days or 90 days. Those who underwent surgery with any overlap showed no difference compared with controls with respect to reoperation, readmission, or emergency room visits at 30 or 90 days. Those whose surgeries involved any overlap showed reduced mortality compared with controls during follow-up.

Dr. Mahotra told OTW, “When rigorously matching patients, using coarsened exact matching, and evaluating whether or not overlapping, non-concurrent, surgery was associated with differing outcomes for patients, no differences were detected. Our work focused on outcomes that are frequently studied but certainly does not address all possible positive or negative outcomes.”

“This work suggests that management of orthopedic surgery populations, at least at the center described, during the timeframe described, is appropriate. Most importantly, this suggests that the longstanding anecdotal feeling that hospitals and institutions can manage surgical practices as described, is appropriate.”

“It is crucially important that we assess, and reassess, the care we provide patients to consistently seek the best outcomes possible.”