TY - JOUR
T1 - Comparison of patient outcomes in 3725 overlapping vs 3633 nonoverlapping neurosurgical procedures using a single institution’s clinical and administrative database
AU - Zygourakis, Corinna C.
AU - Keefe, Malla
AU - Lee, Janelle
AU - Barba, Julio
AU - McDermott, Michael W.
AU - Mummaneni, Praveen V.
AU - Lawton, Michael T.
N1 - Publisher Copyright:
Copyright © 2017 by the Congress of Neurological Surgeons.
PY - 2017/2/1
Y1 - 2017/2/1
N2 - BACKGROUND: Overlapping surgery is a common practice to improve surgical efficiency, but there are limited data on its safety. OBJECTIVE: To analyze the patient outcomes of overlapping vs nonoverlapping surgeries performed by multiple neurosurgeons. METHODS: Retrospective review of 7358 neurosurgical procedures, 2012 to 2015, at an urban academic hospital. Collected variables: patient age, gender, insurance, American Society of Anesthesiologists score, severity of illness, mortality risk, admission type, transfer source, procedure type, surgery date, number of cosurgeons, presence of neurosurgery resident/fellow/another attending, and overlapping vs nonoverlapping surgery. Outcomes: procedure time, length of stay, estimated blood loss, discharge location, 30-day mortality, 30-day readmission, return to operating room, acute respiratory failure, and severe sepsis. Statistics: univariate, then multivariate mixed-effect models. RESULTS: Overlapping surgery patients (n = 3725) were younger and had lower American Society of Anesthesiologists scores, severity of illness, and mortality risk (P < .0001) than nonoverlapping surgery patients (n = 3633). Overlapping surgeries had longer procedure times (214 vs 172 min; P < .0001), but shorter length of stay (7.3 vs 7.9 d; P = .010) and lower estimated blood loss (312 vs 363 mL’s; P = .003). Overlapping surgery patients were more likely to be discharged home (73.6% vs 66.2%; P < .0001), and had lower mortality rates (1.3% vs 2.5%; P = .0005) and acute respiratory failure (1.8% vs 2.6%; P = .021). In multivariate models, there was no significant difference between overlapping and nonoverlapping surgeries for any patient outcomes, except for procedure duration, which was longer in overlapping surgery (estimate = 23.03; P < .001). CONCLUSIONS: When planned appropriately, overlapping surgery can be performed safely within the infrastructure at our academic institution.
AB - BACKGROUND: Overlapping surgery is a common practice to improve surgical efficiency, but there are limited data on its safety. OBJECTIVE: To analyze the patient outcomes of overlapping vs nonoverlapping surgeries performed by multiple neurosurgeons. METHODS: Retrospective review of 7358 neurosurgical procedures, 2012 to 2015, at an urban academic hospital. Collected variables: patient age, gender, insurance, American Society of Anesthesiologists score, severity of illness, mortality risk, admission type, transfer source, procedure type, surgery date, number of cosurgeons, presence of neurosurgery resident/fellow/another attending, and overlapping vs nonoverlapping surgery. Outcomes: procedure time, length of stay, estimated blood loss, discharge location, 30-day mortality, 30-day readmission, return to operating room, acute respiratory failure, and severe sepsis. Statistics: univariate, then multivariate mixed-effect models. RESULTS: Overlapping surgery patients (n = 3725) were younger and had lower American Society of Anesthesiologists scores, severity of illness, and mortality risk (P < .0001) than nonoverlapping surgery patients (n = 3633). Overlapping surgeries had longer procedure times (214 vs 172 min; P < .0001), but shorter length of stay (7.3 vs 7.9 d; P = .010) and lower estimated blood loss (312 vs 363 mL’s; P = .003). Overlapping surgery patients were more likely to be discharged home (73.6% vs 66.2%; P < .0001), and had lower mortality rates (1.3% vs 2.5%; P = .0005) and acute respiratory failure (1.8% vs 2.6%; P = .021). In multivariate models, there was no significant difference between overlapping and nonoverlapping surgeries for any patient outcomes, except for procedure duration, which was longer in overlapping surgery (estimate = 23.03; P < .001). CONCLUSIONS: When planned appropriately, overlapping surgery can be performed safely within the infrastructure at our academic institution.
KW - Concurrent surgery
KW - Overlapping surgery
KW - Patient outcomes
KW - Patient safety
KW - Running 2 rooms
KW - Simultaneous surgery
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U2 - 10.1093/neuros/nyw067
DO - 10.1093/neuros/nyw067
M3 - Article
C2 - 28173545
AN - SCOPUS:85017625053
SN - 0148-396X
VL - 80
SP - 257
EP - 268
JO - Neurosurgery
JF - Neurosurgery
IS - 2
ER -