Overlapping orthopaedic surgery safe in Outpatient setting

A new study published in The Journal of Bone and Joint Surgery has reported that overlapping orthopaedic surgery can be a safe practice in the ambulatory setting.

The data revealed that there is no association between briefly overlapping surgery and surgical site infection, non-infection surgical complications, hospitalization, and morbidity.

The study provides more substantial evidence showing no increase in the risk of complications for patients undergoing overlapping orthopedic surgery – procedures where a single surgeon is a primary surgeon for more than one patient simultaneously in separate operating rooms. Overlapping surgery is commonly used to maximize operating room efficiency.

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"Our data suggest that briefly, overlapping surgery is a safe practice in the ambulatory orthopedic surgery center," comments lead author Charles A. Goldfarb, MD, of Washington University School of Medicine, St. Louis.

Dr. Goldfarb and associates compared the outcomes of overlapping versus nonoverlapping surgery at their university-affiliated orthopedic ambulatory surgical center (ASC). In overlapping surgery, the attending surgeon is present for "critical" parts of the procedure, leaving another surgeon to perform noncritical portions – typically skin closure.

The analysis included more than 22,000 outpatient orthopedic procedures performed between 2009 and 2015. The patients underwent a wide range of elective surgeries, including knee, hand, and shoulder procedures. No joint replacement or spine operations were included in the analysis. The median duration of surgery overlap was 8 minutes and no operations were concurrent.

The study found that the overall complication rate (morbidity) was 0.66 percent in the overlapping surgery group and 0.54 percent in the nonoverlapping surgery group. After the authors adjusted for other factors, the morbidity risk was not significantly different between groups. The same was true for all individual complications considered: surgical site infections, noninfection surgical complications, and transfer to an inpatient hospital.

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Moreover, anesthesia and overall surgery times were slightly longer in the overlapping surgery group, but these surgical factors did not increase the risk of complications.

The study concluded that at least for brief periods, overlapping surgery is safe for patients undergoing outpatient or "same-day" orthopedic surgery procedures

For full information log on to 10.2106/JBJS.18.00244