Comparison of Patient Outcomes in 3725 Overlapping vs 3633 Nonoverlapping Neurosurgical Procedures Using a Single Institution's Clinical and Administrative Database

摘要

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.