Association of Overlapping Surgery with Perioperative Outcomes

Multicenter Perioperative Outcomes Group (MPOG)

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Importance: Overlapping surgery, in which more than 1 procedure performed by the same primary surgeon is scheduled so the start time of one procedure overlaps with the end time of another, is of concern because of potential adverse outcomes. Objective: To determine the association between overlapping surgery and mortality, complications, and length of surgery. Design, Setting, and Participants: Retrospective cohort study of 66430 operations in patients aged 18 to 90 years undergoing total knee or hip arthroplasty; spine surgery; coronary artery bypass graft (CABG) surgery; and craniotomy at 8 centers between January 1, 2010, and May 31, 2018. Patients were followed up until discharge. Exposures: Overlapping surgery (≥2 operations performed by the same surgeon in which ≥1 hour of 1 case, or the entire case for those <1 hour, occurs when another procedure is being performed). Main Outcomes and Measures: Primary outcomes were in-hospital mortality or complications (major: thromboembolic event, pneumonia, sepsis, stroke, or myocardial infarction; minor: urinary tract or surgical site infection) and surgery duration. Results: The final sample consisted of 66430 operations (mean patient age, 59 [SD, 15] years; 31915 women [48%]), of which 8224 (12%) were overlapping. After adjusting for confounders, overlapping surgery was not associated with a significant difference in in-hospital mortality (1.9% overlapping vs 1.6% nonoverlapping; difference, 0.3% [95% CI,-0.2% to 0.7%]; P =.21) or risk of complications (12.8% overlapping vs 11.8% nonoverlapping; difference, 0.9% [95% CI,-0.1% to 1.9%]; P =.08). Overlapping surgery was associated with increased surgery length (204 vs 173 minutes; difference, 30 minutes [95% CI, 24 to 37 minutes]; P <.001). Overlapping surgery was significantly associated with increased mortality and increased complications among patients having a high preoperative predicted risk for mortality and complications, compared with low-risk patients (mortality: 5.8% vs 4.7%; difference, 1.2% [95% CI, 0.1% to 2.2%]; P =.03; complications: 29.2% vs 27.0%; difference, 2.3% [95% CI, 0.3% to 4.3%]; P =.03). Conclusions and Relevance: Among adults undergoing common operations, overlapping surgery was not significantly associated with differences in in-hospital mortality or postoperative complication rates but was significantly associated with increased surgery length. Further research is needed to understand the association of overlapping surgery with these outcomes among specific patient subgroups.

Original languageEnglish (US)
Pages (from-to)762-772
Number of pages11
JournalJAMA - Journal of the American Medical Association
Volume321
Issue number8
DOIs
StatePublished - Feb 26 2019

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Hospital Mortality
Mortality
Surgical Wound Infection
Craniotomy
Urinary Tract
Coronary Artery Bypass
Arthroplasty
Hip
Knee
Sepsis
Pneumonia
Spine
Cohort Studies
Retrospective Studies
Stroke
Myocardial Infarction
Outcome Assessment (Health Care)
Transplants
Research
Surgeons

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Association of Overlapping Surgery with Perioperative Outcomes. / Multicenter Perioperative Outcomes Group (MPOG).

In: JAMA - Journal of the American Medical Association, Vol. 321, No. 8, 26.02.2019, p. 762-772.

Research output: Contribution to journalArticle

Multicenter Perioperative Outcomes Group (MPOG). / Association of Overlapping Surgery with Perioperative Outcomes. In: JAMA - Journal of the American Medical Association. 2019 ; Vol. 321, No. 8. pp. 762-772.
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title = "Association of Overlapping Surgery with Perioperative Outcomes",
abstract = "Importance: Overlapping surgery, in which more than 1 procedure performed by the same primary surgeon is scheduled so the start time of one procedure overlaps with the end time of another, is of concern because of potential adverse outcomes. Objective: To determine the association between overlapping surgery and mortality, complications, and length of surgery. Design, Setting, and Participants: Retrospective cohort study of 66430 operations in patients aged 18 to 90 years undergoing total knee or hip arthroplasty; spine surgery; coronary artery bypass graft (CABG) surgery; and craniotomy at 8 centers between January 1, 2010, and May 31, 2018. Patients were followed up until discharge. Exposures: Overlapping surgery (≥2 operations performed by the same surgeon in which ≥1 hour of 1 case, or the entire case for those <1 hour, occurs when another procedure is being performed). Main Outcomes and Measures: Primary outcomes were in-hospital mortality or complications (major: thromboembolic event, pneumonia, sepsis, stroke, or myocardial infarction; minor: urinary tract or surgical site infection) and surgery duration. Results: The final sample consisted of 66430 operations (mean patient age, 59 [SD, 15] years; 31915 women [48{\%}]), of which 8224 (12{\%}) were overlapping. After adjusting for confounders, overlapping surgery was not associated with a significant difference in in-hospital mortality (1.9{\%} overlapping vs 1.6{\%} nonoverlapping; difference, 0.3{\%} [95{\%} CI,-0.2{\%} to 0.7{\%}]; P =.21) or risk of complications (12.8{\%} overlapping vs 11.8{\%} nonoverlapping; difference, 0.9{\%} [95{\%} CI,-0.1{\%} to 1.9{\%}]; P =.08). Overlapping surgery was associated with increased surgery length (204 vs 173 minutes; difference, 30 minutes [95{\%} CI, 24 to 37 minutes]; P <.001). Overlapping surgery was significantly associated with increased mortality and increased complications among patients having a high preoperative predicted risk for mortality and complications, compared with low-risk patients (mortality: 5.8{\%} vs 4.7{\%}; difference, 1.2{\%} [95{\%} CI, 0.1{\%} to 2.2{\%}]; P =.03; complications: 29.2{\%} vs 27.0{\%}; difference, 2.3{\%} [95{\%} CI, 0.3{\%} to 4.3{\%}]; P =.03). Conclusions and Relevance: Among adults undergoing common operations, overlapping surgery was not significantly associated with differences in in-hospital mortality or postoperative complication rates but was significantly associated with increased surgery length. Further research is needed to understand the association of overlapping surgery with these outcomes among specific patient subgroups.",
author = "{Multicenter Perioperative Outcomes Group (MPOG)} and Eric Sun and Mello, {Michelle M.} and Rishel, {Chris A.} and Vaughn, {Michelle T.} and Sachin Kheterpal and Leif Saager and Fleisher, {Lee A.} and Damrose, {Edward J.} and Bassam Kadry and Jena, {Anupam B.} and Fabian Kooij and Janet Wilczak and Roy Soto and Joshua Berris and Zachary Price and Urman, {Richard D.} and Steven Lins and Harris, {John M.} and Cummings, {Kenneth C.} and Berman, {Mitchell F.} and Masakatsu Nanamori and Adelman, {Bruce T.} and Christopher Wedeven and Bittner, {Edward A.} and John LaGorio and McCormick, {Patrick J.} and Simon Tom and Aziz, {Michael F.} and Michael Aziz and Ellis, {Terri A.} and Susan Molina and William Peterson and Mackey, {Sean C.} and {Van Klei}, {Wilton A.} and Aman Mahajan and Jameson, {Leslie C.} and Biggs, {Daniel A.} and Neuman, {Mark D.} and Craft, {Robert M.} and Pace, {Nathan L.} and Paganelli, {William C.} and Durieux, {Marcel E.} and Nair, {Bala J.} and Wanderer, {Jonathan P.} and Miller, {Scott A.} and Helsten, {Daniel L.} and Turnbull, {Zachary A.} and Schonberger, {Robert B.}",
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TY - JOUR

T1 - Association of Overlapping Surgery with Perioperative Outcomes

AU - Multicenter Perioperative Outcomes Group (MPOG)

AU - Sun, Eric

AU - Mello, Michelle M.

AU - Rishel, Chris A.

AU - Vaughn, Michelle T.

AU - Kheterpal, Sachin

AU - Saager, Leif

AU - Fleisher, Lee A.

AU - Damrose, Edward J.

AU - Kadry, Bassam

AU - Jena, Anupam B.

AU - Kooij, Fabian

AU - Wilczak, Janet

AU - Soto, Roy

AU - Berris, Joshua

AU - Price, Zachary

AU - Urman, Richard D.

AU - Lins, Steven

AU - Harris, John M.

AU - Cummings, Kenneth C.

AU - Berman, Mitchell F.

AU - Nanamori, Masakatsu

AU - Adelman, Bruce T.

AU - Wedeven, Christopher

AU - Bittner, Edward A.

AU - LaGorio, John

AU - McCormick, Patrick J.

AU - Tom, Simon

AU - Aziz, Michael F.

AU - Aziz, Michael

AU - Ellis, Terri A.

AU - Molina, Susan

AU - Peterson, William

AU - Mackey, Sean C.

AU - Van Klei, Wilton A.

AU - Mahajan, Aman

AU - Jameson, Leslie C.

AU - Biggs, Daniel A.

AU - Neuman, Mark D.

AU - Craft, Robert M.

AU - Pace, Nathan L.

AU - Paganelli, William C.

AU - Durieux, Marcel E.

AU - Nair, Bala J.

AU - Wanderer, Jonathan P.

AU - Miller, Scott A.

AU - Helsten, Daniel L.

AU - Turnbull, Zachary A.

AU - Schonberger, Robert B.

PY - 2019/2/26

Y1 - 2019/2/26

N2 - Importance: Overlapping surgery, in which more than 1 procedure performed by the same primary surgeon is scheduled so the start time of one procedure overlaps with the end time of another, is of concern because of potential adverse outcomes. Objective: To determine the association between overlapping surgery and mortality, complications, and length of surgery. Design, Setting, and Participants: Retrospective cohort study of 66430 operations in patients aged 18 to 90 years undergoing total knee or hip arthroplasty; spine surgery; coronary artery bypass graft (CABG) surgery; and craniotomy at 8 centers between January 1, 2010, and May 31, 2018. Patients were followed up until discharge. Exposures: Overlapping surgery (≥2 operations performed by the same surgeon in which ≥1 hour of 1 case, or the entire case for those <1 hour, occurs when another procedure is being performed). Main Outcomes and Measures: Primary outcomes were in-hospital mortality or complications (major: thromboembolic event, pneumonia, sepsis, stroke, or myocardial infarction; minor: urinary tract or surgical site infection) and surgery duration. Results: The final sample consisted of 66430 operations (mean patient age, 59 [SD, 15] years; 31915 women [48%]), of which 8224 (12%) were overlapping. After adjusting for confounders, overlapping surgery was not associated with a significant difference in in-hospital mortality (1.9% overlapping vs 1.6% nonoverlapping; difference, 0.3% [95% CI,-0.2% to 0.7%]; P =.21) or risk of complications (12.8% overlapping vs 11.8% nonoverlapping; difference, 0.9% [95% CI,-0.1% to 1.9%]; P =.08). Overlapping surgery was associated with increased surgery length (204 vs 173 minutes; difference, 30 minutes [95% CI, 24 to 37 minutes]; P <.001). Overlapping surgery was significantly associated with increased mortality and increased complications among patients having a high preoperative predicted risk for mortality and complications, compared with low-risk patients (mortality: 5.8% vs 4.7%; difference, 1.2% [95% CI, 0.1% to 2.2%]; P =.03; complications: 29.2% vs 27.0%; difference, 2.3% [95% CI, 0.3% to 4.3%]; P =.03). Conclusions and Relevance: Among adults undergoing common operations, overlapping surgery was not significantly associated with differences in in-hospital mortality or postoperative complication rates but was significantly associated with increased surgery length. Further research is needed to understand the association of overlapping surgery with these outcomes among specific patient subgroups.

AB - Importance: Overlapping surgery, in which more than 1 procedure performed by the same primary surgeon is scheduled so the start time of one procedure overlaps with the end time of another, is of concern because of potential adverse outcomes. Objective: To determine the association between overlapping surgery and mortality, complications, and length of surgery. Design, Setting, and Participants: Retrospective cohort study of 66430 operations in patients aged 18 to 90 years undergoing total knee or hip arthroplasty; spine surgery; coronary artery bypass graft (CABG) surgery; and craniotomy at 8 centers between January 1, 2010, and May 31, 2018. Patients were followed up until discharge. Exposures: Overlapping surgery (≥2 operations performed by the same surgeon in which ≥1 hour of 1 case, or the entire case for those <1 hour, occurs when another procedure is being performed). Main Outcomes and Measures: Primary outcomes were in-hospital mortality or complications (major: thromboembolic event, pneumonia, sepsis, stroke, or myocardial infarction; minor: urinary tract or surgical site infection) and surgery duration. Results: The final sample consisted of 66430 operations (mean patient age, 59 [SD, 15] years; 31915 women [48%]), of which 8224 (12%) were overlapping. After adjusting for confounders, overlapping surgery was not associated with a significant difference in in-hospital mortality (1.9% overlapping vs 1.6% nonoverlapping; difference, 0.3% [95% CI,-0.2% to 0.7%]; P =.21) or risk of complications (12.8% overlapping vs 11.8% nonoverlapping; difference, 0.9% [95% CI,-0.1% to 1.9%]; P =.08). Overlapping surgery was associated with increased surgery length (204 vs 173 minutes; difference, 30 minutes [95% CI, 24 to 37 minutes]; P <.001). Overlapping surgery was significantly associated with increased mortality and increased complications among patients having a high preoperative predicted risk for mortality and complications, compared with low-risk patients (mortality: 5.8% vs 4.7%; difference, 1.2% [95% CI, 0.1% to 2.2%]; P =.03; complications: 29.2% vs 27.0%; difference, 2.3% [95% CI, 0.3% to 4.3%]; P =.03). Conclusions and Relevance: Among adults undergoing common operations, overlapping surgery was not significantly associated with differences in in-hospital mortality or postoperative complication rates but was significantly associated with increased surgery length. Further research is needed to understand the association of overlapping surgery with these outcomes among specific patient subgroups.

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