Perceptions of overlapping surgery in neurosurgery based on practice volume: A multi-institutional survey

Mohamad Bydon, Mohammed Ali Alvi, Panagiotis Kerezoudis, Joseph A. Hyder, Elizabeth B. Habermann, Samuel Hohmann, Alfredo Quinones-Hinojosa, Frederic B. Meyer, Robert J. Spinner

Research output: Contribution to journalArticle

Abstract

Objective: Overlapping surgery, accepted by many as two distinct operations occurring at the same time but without coincident critical portions, has been said to improve patient access to surgical care. With recent controversy, some are opposed to this practice due to concerns regarding its safety. In this manuscript, we sought to investigate the perceptions of overlapping surgery among neurosurgical leadership and the association of these perceptions with neurosurgical case volume. Patients and Methods: We conducted a self-administered survey of neurosurgery department chair and residency program directors of institutions participating in the Vizient Clinical Database/Resource (CDB/RM), an administrative database of 117 United States (US) medical centers and their 300 affiliated hospitals. We queried participants regarding yearly departmental case-volume, frequency of overlapping surgery in daily practice and the degree of overlapping they find acceptable. Results: Of the 236 surveys disseminated, a total of 70 responses were received with a response rate of 29.7.%, which is comparable to previously reported response rates among neurosurgeons and other physicians. Our respondents consisted of 43 of 165 chairs (26.1.%) and 27 of 66 program directors (40.0.%) representing 64 unique hospitals/institutions out of 216 (29.6.%). Based on the responses to question involving case volume, we divided our responders into high volume hospitals (HVH) (n = 44; > 2000 cases per year) and low volume hospitals (LVH) (N = 26). More HVH were found to have frequent occurrence of overlapping surgery (50% weekly and 20.9.% daily vs LVH's 26.9.% weekly and 3.8.% daily, p = 0.003) and considered two overlapping surgeries without overlap of critical portion as acceptable (38.6.% vs 26.9.%, p = 0.10). Conclusions: Our survey results showed that neurosurgical departments with high-volume practices were more likely to practice overlapping surgery on a regular basis and to view it as an acceptable practice. The association between overlapping surgery and the volume-outcome relationship should be further evaluated.

Original languageEnglish (US)
Article number105585
JournalClinical Neurology and Neurosurgery
Volume188
DOIs
StatePublished - Jan 2020

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Neurosurgery
High-Volume Hospitals
Low-Volume Hospitals
Databases
Internship and Residency
Surveys and Questionnaires
Physicians
Safety

Keywords

  • Concurrent surgery
  • Hospital volume
  • Neurosurgery
  • Overlapping surgery
  • Patient access
  • Surgical outcomes

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Perceptions of overlapping surgery in neurosurgery based on practice volume : A multi-institutional survey. / Bydon, Mohamad; Alvi, Mohammed Ali; Kerezoudis, Panagiotis; Hyder, Joseph A.; Habermann, Elizabeth B.; Hohmann, Samuel; Quinones-Hinojosa, Alfredo; Meyer, Frederic B.; Spinner, Robert J.

In: Clinical Neurology and Neurosurgery, Vol. 188, 105585, 01.2020.

Research output: Contribution to journalArticle

Bydon, Mohamad ; Alvi, Mohammed Ali ; Kerezoudis, Panagiotis ; Hyder, Joseph A. ; Habermann, Elizabeth B. ; Hohmann, Samuel ; Quinones-Hinojosa, Alfredo ; Meyer, Frederic B. ; Spinner, Robert J. / Perceptions of overlapping surgery in neurosurgery based on practice volume : A multi-institutional survey. In: Clinical Neurology and Neurosurgery. 2020 ; Vol. 188.
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abstract = "Objective: Overlapping surgery, accepted by many as two distinct operations occurring at the same time but without coincident critical portions, has been said to improve patient access to surgical care. With recent controversy, some are opposed to this practice due to concerns regarding its safety. In this manuscript, we sought to investigate the perceptions of overlapping surgery among neurosurgical leadership and the association of these perceptions with neurosurgical case volume. Patients and Methods: We conducted a self-administered survey of neurosurgery department chair and residency program directors of institutions participating in the Vizient Clinical Database/Resource (CDB/RM), an administrative database of 117 United States (US) medical centers and their 300 affiliated hospitals. We queried participants regarding yearly departmental case-volume, frequency of overlapping surgery in daily practice and the degree of overlapping they find acceptable. Results: Of the 236 surveys disseminated, a total of 70 responses were received with a response rate of 29.7.{\%}, which is comparable to previously reported response rates among neurosurgeons and other physicians. Our respondents consisted of 43 of 165 chairs (26.1.{\%}) and 27 of 66 program directors (40.0.{\%}) representing 64 unique hospitals/institutions out of 216 (29.6.{\%}). Based on the responses to question involving case volume, we divided our responders into high volume hospitals (HVH) (n = 44; > 2000 cases per year) and low volume hospitals (LVH) (N = 26). More HVH were found to have frequent occurrence of overlapping surgery (50{\%} weekly and 20.9.{\%} daily vs LVH's 26.9.{\%} weekly and 3.8.{\%} daily, p = 0.003) and considered two overlapping surgeries without overlap of critical portion as acceptable (38.6.{\%} vs 26.9.{\%}, p = 0.10). Conclusions: Our survey results showed that neurosurgical departments with high-volume practices were more likely to practice overlapping surgery on a regular basis and to view it as an acceptable practice. The association between overlapping surgery and the volume-outcome relationship should be further evaluated.",
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T2 - A multi-institutional survey

AU - Bydon, Mohamad

AU - Alvi, Mohammed Ali

AU - Kerezoudis, Panagiotis

AU - Hyder, Joseph A.

AU - Habermann, Elizabeth B.

AU - Hohmann, Samuel

AU - Quinones-Hinojosa, Alfredo

AU - Meyer, Frederic B.

AU - Spinner, Robert J.

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N2 - Objective: Overlapping surgery, accepted by many as two distinct operations occurring at the same time but without coincident critical portions, has been said to improve patient access to surgical care. With recent controversy, some are opposed to this practice due to concerns regarding its safety. In this manuscript, we sought to investigate the perceptions of overlapping surgery among neurosurgical leadership and the association of these perceptions with neurosurgical case volume. Patients and Methods: We conducted a self-administered survey of neurosurgery department chair and residency program directors of institutions participating in the Vizient Clinical Database/Resource (CDB/RM), an administrative database of 117 United States (US) medical centers and their 300 affiliated hospitals. We queried participants regarding yearly departmental case-volume, frequency of overlapping surgery in daily practice and the degree of overlapping they find acceptable. Results: Of the 236 surveys disseminated, a total of 70 responses were received with a response rate of 29.7.%, which is comparable to previously reported response rates among neurosurgeons and other physicians. Our respondents consisted of 43 of 165 chairs (26.1.%) and 27 of 66 program directors (40.0.%) representing 64 unique hospitals/institutions out of 216 (29.6.%). Based on the responses to question involving case volume, we divided our responders into high volume hospitals (HVH) (n = 44; > 2000 cases per year) and low volume hospitals (LVH) (N = 26). More HVH were found to have frequent occurrence of overlapping surgery (50% weekly and 20.9.% daily vs LVH's 26.9.% weekly and 3.8.% daily, p = 0.003) and considered two overlapping surgeries without overlap of critical portion as acceptable (38.6.% vs 26.9.%, p = 0.10). Conclusions: Our survey results showed that neurosurgical departments with high-volume practices were more likely to practice overlapping surgery on a regular basis and to view it as an acceptable practice. The association between overlapping surgery and the volume-outcome relationship should be further evaluated.

AB - Objective: Overlapping surgery, accepted by many as two distinct operations occurring at the same time but without coincident critical portions, has been said to improve patient access to surgical care. With recent controversy, some are opposed to this practice due to concerns regarding its safety. In this manuscript, we sought to investigate the perceptions of overlapping surgery among neurosurgical leadership and the association of these perceptions with neurosurgical case volume. Patients and Methods: We conducted a self-administered survey of neurosurgery department chair and residency program directors of institutions participating in the Vizient Clinical Database/Resource (CDB/RM), an administrative database of 117 United States (US) medical centers and their 300 affiliated hospitals. We queried participants regarding yearly departmental case-volume, frequency of overlapping surgery in daily practice and the degree of overlapping they find acceptable. Results: Of the 236 surveys disseminated, a total of 70 responses were received with a response rate of 29.7.%, which is comparable to previously reported response rates among neurosurgeons and other physicians. Our respondents consisted of 43 of 165 chairs (26.1.%) and 27 of 66 program directors (40.0.%) representing 64 unique hospitals/institutions out of 216 (29.6.%). Based on the responses to question involving case volume, we divided our responders into high volume hospitals (HVH) (n = 44; > 2000 cases per year) and low volume hospitals (LVH) (N = 26). More HVH were found to have frequent occurrence of overlapping surgery (50% weekly and 20.9.% daily vs LVH's 26.9.% weekly and 3.8.% daily, p = 0.003) and considered two overlapping surgeries without overlap of critical portion as acceptable (38.6.% vs 26.9.%, p = 0.10). Conclusions: Our survey results showed that neurosurgical departments with high-volume practices were more likely to practice overlapping surgery on a regular basis and to view it as an acceptable practice. The association between overlapping surgery and the volume-outcome relationship should be further evaluated.

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KW - Hospital volume

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KW - Overlapping surgery

KW - Patient access

KW - Surgical outcomes

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