Overlapping Surgeries Are Not Associated With Worse Patient Outcomes: Retrospective Multivariate Analysis of 14 872 Neurosurgical Cases Performed at a Single Institution.

ABSTRACT

BACKGROUND: Overlapping surgeries have recently become a controversial topic. OBJECTIVE: To evaluate the effect of overlapping surgeries on patient outcomes. METHODS: A retrospective analysis of all neurosurgical procedures performed at a single institution from July 2013 to May 2016 was conducted. Variables extracted from the electronic medical records included sex, age, procedure type, resident years of training, evening case, emergency case, American Society of Anesthesiologists Physical Status Score, illness severity, mortality risk, and percentage of case overlap. Univariate and multivariate analyses were performed for the following primary outcomes: procedure length, length of hospital stay, return to operating room (OR), disposition upon discharge, hospital readmission, and mortality. Separate analyses were performed for overlap thresholds of 0%, 20%, 50%, and 100%. RESULTS: A total of 14 872 cases were performed during the study period, and all were included in the statistical analyses. Univariate analysis showed a benefit for overlapping surgeries in terms of hospital length of stay, return to OR, and disposition status (all P < .001). No difference was found for hospital readmission or mortality. Overlapping surgeries were significantly longer and were staffed by more senior residents (P < .001). Multivariate analysis showed a benefit for overlapping surgeries, or no difference, for all the measured outcomes except procedure length. CONCLUSION: These results reject the hypothesis that overlapping surgeries are predictive of worse outcomes. When considered in the context of the current debate regarding overlapping surgeries, these results argue against claims that overlapping surgeries are dangerous or harmful to patients.