Overlapping surgery increases risk for complications after hip surgery

William G. Hamilton, MD

This study addresses the timely and controversial subject of overlapping surgery. Surgeons, hospital administrators and the U.S. Senate are all in need of data to evaluate the safety of this common practice.

Using a regional database from Ontario, Canada, the 1-year complication rate of cases performed in an overlapping fashion are compared to those performed consecutively in one room, evaluating both hip fractures and elective total hip arthroplasty. The higher rate of complications in the overlapping group raises concerns for the surgeons and hospitals in that region, and those centers should be evaluating whether this practice is appropriate. In fact, it is wise for all hospitals and surgeons to evaluate their outcomes to determine if there is any compromise to patient safety when surgeons utilize overlapping rooms. Just as a single study showing no change in complication rate with overlapping rooms does not prove this practice to be safe, one study showing an increased rate of complications does not prove it to be dangerous.

Because a small minority of cases were performed in an overlapping fashion (<3%), it is clear that this practice in Ontario, Canada is exceedingly rare. To successfully manage overlapping rooms, physicians (including anesthesia staff and surgeons), staff and providers must have good communication, efficiency and timing. This requires repetition to perfect, and is likely not optimized if done rarely. This paper may not be representative of those centers that do it commonly and efficiently.

As this debate evolves, surgeons must keep patient safety in the forefront of their minds. Surgeons should not routinely practice concurrent surgery (where the critical portions of two surgeries occur simultaneously). They should inform their patients if they are utilizing overlapping rooms, and they should designate qualified providers to assist with non-critical portions of the procedure whether it is patient transport, positioning or wound closure. Each center should monitor their outcomes to make sure there is no compromise to patient safety when these tactics are employed; the future of our patients’ trust depends on it.