At least for brief periods, overlapping surgery is safe for patients undergoing outpatient or “same-day” orthopaedic surgery procedures, according to a study published recently in The Journal of Bone & Joint Surgery.
“Our data suggest that briefly overlapping surgery is a safe practice in the ambulatory orthopaedic surgery center,” comments lead author Charles A. Goldfarb, MD, of Washington University School of Medicine, St Louis, in a media release from Wolters Kluwer Health: Lippincott Williams and Wilkins.
In the study, Goldfarb and colleagues compared the outcomes of overlapping versus nonoverlapping surgery at their university-affiliated orthopaedic ambulatory surgical center (ASC). In overlapping surgery, the attending surgeon is present for “critical” parts of the procedure, leaving another surgeon to perform noncritical portions – typically, skin closure. Overlapping surgery is commonly used to maximize operating room efficiency.
The analysis included more than 22,000 outpatient orthopaedic procedures performed between 2009 and 2015. The patients underwent a wide range of elective surgeries, including knee, hand, and shoulder procedures. No joint replacement or spine operations were included in the analysis.
Twenty-three percent of the procedures were overlapping surgeries. Median overlap time in these procedures was 8 minutes. According to this ASC’s policy, another attending surgeon—not a resident or fellow in training—was present during the overlapping portion of the procedure, the release explains.
The overall complication rate (morbidity) was 0.66% in the overlapping surgery group and 0.54% in the nonoverlapping surgery group. After the authors adjusted for other factors, the morbidity risk was not significantly different between groups. The same was true for all individual complications considered: surgical site infections, noninfection surgical complications, and transfer to an inpatient hospital.
Anesthesia and overall surgery times were slightly longer in the overlapping surgery group, but these surgical factors did not increase the risk of complications.
The researchers note that although this study includes a large number of outpatient orthopaedic surgery cases, the data represent the experience of only one ASC. Nevertheless, the results suggest that overlapping orthopaedic surgery can be safely carried out in ambulatory surgery settings— at least as practiced at the authors’ institution.
Goldfarb and colleagues conclude in the release that, “Practitioners, payors, and patients should be reassured that limited overlapping surgery is appropriate and reasonable in this setting.”
[Source(s): Wolters Kluwer Health: Lippincott Williams and Wilkins; Newswise]