TY - JOUR
T1 - Safety of Overlapping Surgery at a High-volume Referral Center
AU - Hyder, Joseph A.
AU - Hanson, Kristine T.
AU - Storlie, Curtis
AU - Glasgow, Amy
AU - Madde, Nageswar R.
AU - Brown, Michael J.
AU - Kor, Daryl J
AU - Cima, Robert R.
AU - Habermann, Elizabeth B
PY - 2016/12/5
Y1 - 2016/12/5
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85002168968&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85002168968&partnerID=8YFLogxK
U2 - 10.1097/SLA.0000000000002084
DO - 10.1097/SLA.0000000000002084
M3 - Article
C2 - 27922837
AN - SCOPUS:85002168968
SN - 0003-4932
JO - Annals of Surgery
JF - Annals of Surgery
ER -