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ROCHESTER, MN — Scheduling overlapping surgeries expands access to care and improves hospital efficiency, but at what cost to patient outcomes?
A new study published in the Annals of Surgery finds the practice to be safe compared to non-overlapping surgeries, with no difference in the rates of postoperative complications or deaths within a month after surgery groups.
For the study, Mayo Clinic researchers used data from the University HealthSystem Consortium, an alliance of academic medical centers whose members include Mayo Clinic, to match 10,614 overlapping surgeries to 16,111 non-overlapping procedures performed at Mayo in Rochester.
An additional analysis — using more than 10,000 operations at the Rochester location, including about 3,000 with overlap, matched by surgeons from the American College of Surgeons-National Surgical Quality Improvement Program — also found no differences in outcomes.
Results suggest, in fact, that adjusted odds ratio for inpatient mortality was greater for non-overlapping procedures — 2.14 — as opposed to overlapping procedures, while length of stay was no different. In confirmatory analyses, the 30-day mortality had an adjusted OR of 0.69 for non-overlapping vs overlapping procedures, with no clinically significant difference in morbidity or length of stay.
"Our data show that overlapping surgery as practiced here is safe," explained co-author Robert Cima, MD, a colorectal surgeon and chair of surgical quality at Mayo Clinic's Rochester campus. "We think it provides value to our patients because it allows more patients timely access to surgery and care by expert teams."
Study authors made it clear their study looked at overlapping surgery, not concurrent surgery. Background information in the article explained the difference: Overlapping surgeries are staggered so that "critical portions" do not occur at the same time; i.e., the surgeon is present for the critical portions of each operation and immediately available for non-critical portions such as closing the wound.
In concurrent surgery, on the other hand, a surgeon also has two patients in operating suites at the same time, but the critical portions of the surgeries overlap. The report points out that concurrent surgery is rare and is not allowed by Medicare.
“These findings from administrative and clinical registries support the safety of overlapping surgical procedures at this center, but may not extrapolate to other centers,” study authors cautioned.