By Jake Miller, Harvard Gazette
A surgeon sometimes moves from one operation to the next before the first one is completed, leaving junior surgeons, residents, and physician assistants to complete the noncritical portions of the procedure.
The practice happens tens of thousands of times a year in U.S. hospitals, but are such overlapping operations safe?
For the most part they are, but with two important exceptions, according to research by investigators at Harvard Medical School and Stanford University published in the Journal of the American Medical Association (JAMA) and thought to be one of the most comprehensive analyses on the subject to date.
The results, based on a comparison of outcomes from more than 60,000 operations, reveal that overall, overlapping surgeries do not increase the risk for postsurgical complications or patient death in the immediate aftermath of the procedure. However, there were two important exceptions. Patients deemed to be at high risk — those with a relatively high predicted probability of complications from surgery, due to age and pre-existing medical conditions — and patients undergoing coronary artery bypass experienced higher mortality and complication rates during overlapping surgeries. Additionally, overlapping procedures ran about a half-hour longer on average than nonoverlapping procedures, the study found.
“For most surgeries, and most patients, our findings should be reassuring,” said senior author Anupam Jena, the Ruth L. Newhouse Associate Professor of Health Care Policy at the Blavatnik Institute at Harvard Medical School and an internal medicine physician at Massachusetts General Hospital. “But for certain types of procedures and certain patients, the evidence suggests that we need to be thoughtful about whether a particular individual is a good candidate for overlapping surgery.”
Careful patient selection and an individualized approach based on the patient’s risk profile and pre-existing conditions are critical, the researchers added.
Additionally, the investigators caution, the study was designed to capture only mortality and complication rates during the brief hospitalization period following surgery. It did not measure long-term mortality and complications among patients once they were discharged.
The mortality rate was 1.6 percent for patients undergoing nonoverlapping surgeries, compared with 1.9 percent among patients undergoing overlapping procedures. Postoperative complications occurred in 11.8 percent of patients undergoing nonoverlapping procedures, compared with 12.8 percent among those undergoing overlapping surgeries. Overlapping surgeries ran notably longer — 204 minutes, compared with 173 minutes for nonoverlapping procedures.
For high-risk patients, the mortality rate was 5.8 percent for patients undergoing overlapping surgeries, compared with 4.7 percent among patients undergoing nonoverlapping procedures. The complication rate was 29.2 percent for patients undergoing overlapping surgeries, compared with 27 percent among patients undergoing nonoverlapping procedures.
