Overlapping surgery seen as safe for most patients, but caution given for certain high-risk cases

Overlapping surgery did not significantly correlate with differences in in-hospital mortality or postoperative complication rates; however, it was significantly associated with longer surgery among patients who underwent common procedures, according to a recently published study.

For the study, overlapping surgery was defined as at least two operations that were performed by the same surgeon in which at least 1 hour of one case, or the entire case for procedures that took less than 1 hour, occurred when another surgery was performed.

“The take-home message of the study is that, overall, overlapping surgery seems to be safe for most patients, in that complications and mortality are no higher among patients who undergo overlapping surgery,” study co-author Eric Sun, MD, PhD, told Healio.com/Orthopedics. “That said, our study did suggest that among certain patients – namely those undergoing [coronary artery bypass graft] CABG and those at high predicted risk of complications following surgery based on age, comorbidities or type of surgery – there may be increased risk of complications and mortality, though that risk increase was small in size.”

Researchers performed a retrospective cohort study of 66,430 total knee or hip arthroplasties, spine surgeries, CABG surgeries and craniotomies performed in patients between 18 and 90 years old. Investigators followed patients until they were discharged. In-house mortality, complications and surgery duration were among the primary outcomes.

Results showed that of the 66,430 operations, 8,224 were considered overlapping surgeries. After the cofounders were adjusted, investigators found overlapping surgery did not correlate with a significant difference in in-house mortality or complication risks. There was an association between overlapping surgery and longer surgery. Investigators noted overlapping surgery significantly correlated with increased mortality and complications in patients with high preoperative predicted mortality risk and risk for complications vs. low-risk patients. – by Monica Jaramillo

Disclosures: Sun reports he receives grants from the National Institute on Drug Abuse. Please see the full study for a list of all other authors’ relevant financial disclosures.

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Source:

Sun E, et al. JAMA. 2019;doi:10.1001/jama.2019.0711.