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The primary objective of this study was to analyze the relationship of percentage of surgical overlap with patient outcomes to determine if a detrimental level of overlap exists.Overlapping surgery (OS) is defined as one attending physician supervising two or more operative cases simultaneously, without the critical portions of the cases occurring concurrently. To date, no study has examined the relationship of percent overlap, or the percentage of one case that is spent overlapping with another, to outcomes, efficiency, safety, and complications.This study is a retrospective cohort study conducted at a large tertiary referral center. The primary outcomes of interest included operative duration, in-hospital mortality, 30-day readmission, and patient safety indicators (PSIs). The Cochran-Armitage test for trend was used to evaluate the outcomes of interest. P values of ≤0.05 were considered statistically significant.A total of 87,426 cases were included in this study. There were 62,332 cases without overlap (Group 0), 10,514 cases with 1-25% overlap (Group 1), 5,303 cases with 26-50% overlap (Group 2), 4,296 cases with 51-75% overlap (Group 3), and 4,981 cases with75% overlap (Group 4). In-hospital mortality decreased as overlap increased (ptrend0.0001). Operative time increased with increasing overlap (ptrend0.0001) while readmission rates showed no statistical significance between groups (ptrend=0.5078). Rates of patient safety indicators were lower for Groups 1, 2 and 3 (1.69%, 2.01% and 2.08%) when compared to Group 0 (2.24%). Group 4 had the highest rate of patient safety indicators at 2.35% (P=0.0086).Overlapping surgery was shown to have reduced in-hospital mortality and similar patient safety indicator and readmission rates when compared to non-overlapping cases. Operative time was shown to increase in overlapping surgeries when compared to non-overlapping surgeries. The results from this study indicate that the percentage of surgical overlap does not detrimentally affect most patient outcomes, especially with overlap of less than 75%. |
