门诊骨科环境下的重叠手术
Overlapping Surgery in the Ambulatory Orthopaedic Setting.
作者信息
Zhang Alan L, Sing David C, Dang Debbie Y, Ma C Benjamin, Black Dennis, Vail Thomas P, Feeley Brian T
机构信息
Departments of Orthopaedic Surgery (A.L.Z., D.C.S., D.Y.D., C.B.M., T.P.V., and B.T.F.) and Epidemiology and Biostatistics (D.B.), University of California at San Francisco, San Francisco, California
Departments of Orthopaedic Surgery (A.L.Z., D.C.S., D.Y.D., C.B.M., T.P.V., and B.T.F.) and Epidemiology and Biostatistics (D.B.), University of California at San Francisco, San Francisco, California.
出版信息
J Bone Joint Surg Am. 2016 Nov 16;98(22):1859-1867. doi: 10.2106/JBJS.16.00248.
BACKGROUND
The practice of a surgeon performing procedures in two operating rooms during overlapping time frames has been described as concurrent surgery if critical portions occur simultaneously, or overlapping surgery if they do not. Although recent media reports have focused on the potential adverse effects of these practices, to our knowledge, there has been no previous research investigating outcomes of overlapping procedures in orthopaedic surgery.
METHODS
A retrospective review of an institutional clinical database from 2012 to 2015 was utilized to collect data from all surgical cases (including sports medicine, hand, and foot and ankle) performed at an ambulatory orthopaedic surgery center. Patient demographic characteristics, types of procedures, operating room time, procedure time, and 30-day outcomes including complications, unplanned hospital readmissions, unplanned reoperations, and emergency department visits were collected. The amount of overlap time between cases was also analyzed. Pearson chi-square tests, Student t tests, and logistic regression were used for statistical analysis.
RESULTS
Of 3,640 cases performed, 68% were overlapping procedures and 32% were non-overlapping. There was no difference in the mean age, sex, body mass index, American Society of Anesthesiologists rating, or Charlson Comorbidity Index between patients who had overlapping procedures and those who did not. Comparison of overlapping surgery cases and non-overlapping surgery cases revealed no difference in the mean procedure time (70.7 minutes compared with 72.8 minutes; p = 0.116) or total operating room time (105.4 minutes compared with 105.5 minutes; p = 0.949). Complications were tracked for 30 days after procedures and yielded a rate of 1.1% for overlapping surgeries and 1.3% for non-overlapping surgeries (p = 0.811). Stratification based on subspecialty surgery also demonstrated no difference in complications between the cohorts. Fifty percent of overlapping cases overlapped by <1 hour of operating room time, but 7% overlapped by >2 hours. The rate of complications was found to have no association with the amount of overlap between cases (p = 0.151).
CONCLUSIONS
Overlapping surgery yields equivalent patient operating room time, procedure time, and 30-day complication rates as non-overlapping surgery in the ambulatory orthopaedic setting. Further investigation is warranted for inpatient orthopaedic procedures and across all orthopaedic subspecialties.
LEVEL OF EVIDENCE
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
背景
如果关键部分同时进行，外科医生在重叠时间段内在两个手术室进行手术的做法被称为同步手术；如果关键部分不同时进行，则称为重叠手术。尽管最近的媒体报道关注了这些做法的潜在不良影响，但据我们所知，此前尚无研究调查骨科手术中重叠手术的结果。
方法
对2012年至2015年机构临床数据库进行回顾性研究，以收集在一家门诊骨科手术中心进行的所有手术病例（包括运动医学、手部以及足踝部手术）的数据。收集患者的人口统计学特征、手术类型、手术室时间、手术时间以及30天的结果，包括并发症、计划外住院再入院、计划外再次手术以及急诊就诊情况。还分析了病例之间的重叠时间量。使用Pearson卡方检验、学生t检验和逻辑回归进行统计分析。
结果
在3640例手术病例中，68%为重叠手术，32%为非重叠手术。进行重叠手术的患者与未进行重叠手术的患者在平均年龄、性别、体重指数、美国麻醉医师协会分级或Charlson合并症指数方面没有差异。重叠手术病例与非重叠手术病例的比较显示，平均手术时间（分别为70.7分钟和72.8分钟；p = 0.116）或总手术室时间（分别为105.4分钟和105.5分钟；p = 0.949）没有差异。术后对并发症进行了30天的跟踪，重叠手术的并发症发生率为1.1%，非重叠手术为1.3%（p = 0.811）。基于亚专科手术的分层分析也显示两组之间并发症无差异。50%的重叠病例手术室时间重叠少于1小时，但7%的病例重叠超过2小时。发现并发症发生率与病例之间的重叠量无关（p = 0.151）。
结论
在门诊骨科环境中，重叠手术与非重叠手术相比，患者的手术室时间、手术时间以及30天并发症发生率相当。对于住院骨科手术以及所有骨科亚专科，有必要进行进一步研究。
证据水平
治疗性三级证据。有关证据水平的完整描述，请参阅作者指南。
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