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Safety of Overlapping Surgery at a High-volume Referral Center

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Abstract

Objective:

To compare safety profiles of overlapping and nonoverlapping surgical procedures at a large tertiary-referral center where overlapping surgery is performed.

Background:

Surgical procedures are frequently performed as overlapping, wherein one surgeon is responsible for 2 procedures occurring at the same time, but critical portions are not coincident. The safety of this practice has not been characterized.

Methods:

Primary analyses included elective, adult, inpatient surgical procedures from January 2013 to September 2015 available through University HealthSystem Consortium. Overlapping and nonoverlapping procedures were matched in an unbalanced manner (m:n) by procedure type. Confirmatory analyses from the American College of Surgeons-National Surgical Quality Improvement Program investigated elective surgical procedures from January 2011 to December 2014. We compared outcomes mortality and length of stay after adjustment for registry-predicted risk, case-mix, and surgeon using mixed models.

Results:

The University HealthSystem Consortium sample included 10,765 overlapping cases, of which 10,614 (98.6%) were matched to 16,111 nonoverlapping procedures. Adjusted odds ratio for inpatient mortality was greater for nonoverlapping procedures (adjusted odds ratio, OR = 2.14 vs overlapping procedures; 95% confidence interval, CI 1.23–3.73; P = 0.007) and length of stay was no different (+1% for nonoverlapping cases; 95% CI, −1% to +2%; P = 0.50). In confirmatory analyses, 93.7% (3712/3961) of overlapping procedures matched to 5,637 nonoverlapping procedures. The 30-day mortality (adjusted OR = 0.69 nonoverlapping vs overlapping procedures; 95% CI, 0.13–3.57; P = 0.65), morbidity (adjusted OR = 1.11; 95% CI, 0.92–1.35; P = 0.27) and length of stay (−4% for nonoverlapping; 95% CI, −4% to −3%; P < 0.001) were not clinically different.

Conclusions:

These findings from administrative and clinical registries support the safety of overlapping surgical procedures at this center but may not extrapolate to other centers.

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