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Research Shows that Overlapping Surgeries are Generally Safe (some exceptions may apply)

Posted Monday, March 11, 2019 by Morgan Cartwright

A series produced by the Seattle Times in 2017 covered the practice of overlapping brain and spine surgeries done without informing patients of the practice. While the articles touched off discussions on the practice, facilities varied in their responses: some banned the practice outright, while others allow the practice after disclosing the possibility of overlapping surgeries to patients as part of the informed consent process.

A report of research studying the issue was issued in early 2019: “Is surgery safe as practiced in academic environments that balance the needs of safe patient care with those required to train the next generation of surgeons? The answer appears to be ‘yes’.” The caveat is that overall, while overlapping surgery is probably a safe practice for most patients, different procedures and high-risk patients see a higher rate of complications and/or death.

Researchers looked at 66,430 operations in patients aged 18-90, undergoing total knee or hip replacements, spine surgery, coronary artery bypass graft surgery, and craniotomies at eight centers over eight years between 2010 and 2018. Of the 66,340 operations, 8,224 (12%) were overlapping.

“Overlapping surgery” was defined as two or more operations performed by the same surgeon in which more than one hour of one case, or, if one case is less than an hour the entire case, occurs when another operation is being performed. The practice is often seen as critical for training surgical residents, who need exposure to parts of surgeries over the course of their fellowships to ultimately perform full surgeries independently. High-risk patients were classified based on age, health, and comorbidities.

The study found overlapping surgery was overall not associated with a significant difference of mortality (1.9% overlapping v. 1.6% non-overlapping) or risk of complications (12.8% v. 11.9%). Overlapping surgeries did result in increased surgery length, which puts patients at greater risk (e.g. longer time under anesthesia), as well as possibly higher bills related to longer surgery times.

Overlapping surgery was found to be significantly worse for high risk patients: with increased rates of mortality (5.8% v. 4.7%) and complications (29.2% v. 27%). And the study found higher rates of complications for specific overlapping procedures, such as coronary artery bypass grafts.

Admittedly, the study was limited in that it did not account for whether overlapping procedures were the result of emergencies, or whether surgeons were more likely to overlap surgeries in low-risk patients. The authors acknowledged that further study is needed to understand the association of overlapping surgery among specific patient subgroups.

Further research should continue to shed light on appropriateness of overlapping surgeries in different patients, and for different circumstances, while benefiting overall patient outcomes.

You can read more here:

Study: High-risk patients may have worse outcomes when surgeons are double-booked

Overlapping Surgery and Perioperative Outcomes

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