Liu Jason B, Berian Julia R, Ban Kristen A, Liu Yaoming, Cohen Mark E, Angelos Peter, Matthews Jeffrey B, Hoyt David B, Hall Bruce L, Ko Clifford Y
*American College of Surgeons, Chicago, IL †Department of Surgery, University of Chicago Medicine, Chicago, IL ‡Department of Surgery, Loyola University Medical Center, Maywood, IL §Department of Surgery, Washington University, St. Louis, MO ¶Center for Health Policy and the Olin Business School at Washington University, St. Louis, MO ||Saint Louis Veterans Affairs Medical Center, St. Louis, MO **BJC Healthcare, St. Louis, MO ††Department of Surgery, University of California Los Angeles David Geffen School of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, CA.
Ann Surg. 2017 Sep;266(3):411-420. doi: 10.1097/SLA.0000000000002358.
To determine whether concurrently performed operations are associated with an increased risk for adverse events.
Concurrent operations occur when a surgeon is simultaneously responsible for critical portions of 2 or more operations. How this practice affects patient outcomes is unknown.
Using American College of Surgeons' National Surgical Quality Improvement Program data from 2014 to 2015, operations were considered concurrent if they overlapped by ≥60 minutes or in their entirety. Propensity-score-matched cohorts were constructed to compare death or serious morbidity (DSM), unplanned reoperation, and unplanned readmission in concurrent versus non-concurrent operations. Multilevel hierarchical regression was used to account for the clustered nature of the data while controlling for procedure and case mix.
There were 1430 (32.3%) surgeons from 390 (77.7%) hospitals who performed 12,010 (2.3%) concurrent operations. Plastic surgery (n = 393 [13.7%]), otolaryngology (n = 470 [11.2%]), and neurosurgery (n = 2067 [8.4%]) were specialties with the highest proportion of concurrent operations. Spine procedures were the most frequent concurrent procedures overall (n = 2059/12,010 [17.1%]). Unadjusted rates of DSM (9.0% vs 7.1%; P < 0.001), reoperation (3.6% vs 2.7%; P < 0.001), and readmission (6.9% vs 5.1%; P < 0.001) were greater in the concurrent operation cohort versus the non-concurrent. After propensity score matching and risk-adjustment, there was no significant association of concurrence with DSM (odds ratio [OR] 1.08; 95% confidence interval [CI] 0.96-1.21), reoperation (OR 1.16; 95% CI 0.96-1.40), or readmission (OR 1.14; 95% CI 0.99-1.29).
In these analyses, concurrent operations were not detected to increase the risk for adverse outcomes. These results do not lessen the need for further studies, continuous self-regulation and proactive disclosure to patients.
确定同时进行的手术是否与不良事件风险增加相关。
当一名外科医生同时负责两台或更多手术的关键部分时，就会出现同时进行的手术。这种做法如何影响患者预后尚不清楚。
利用美国外科医师学会2014年至2015年国家外科质量改进计划的数据，如果手术重叠≥60分钟或完全重叠，则视为同时进行的手术。构建倾向得分匹配队列，以比较同时进行的手术与非同时进行的手术中的死亡或严重并发症（DSM）、计划外再次手术和计划外再入院情况。使用多水平分层回归来考虑数据的聚类性质，同时控制手术和病例组合。
来自390家（77.7%）医院的1430名（32.3%）外科医生进行了12010例（2.3%）同时进行的手术。整形外科（n = 393 [13.7%]）、耳鼻喉科（n = 470 [11.2%]）和神经外科（n = 2067 [8.4%]）是同时进行手术比例最高的专科。脊柱手术是总体上最常见的同时进行的手术（n = 2059/12010 [17.1%]）。同时进行的手术队列中的DSM未调整率（9.0%对7.1%；P < 0.001）、再次手术率（3.6%对2.7%；P < 0.001）和再入院率（6.9%对5.1%；P < 0.001）高于非同时进行的手术队列。在倾向得分匹配和风险调整后，同时进行手术与DSM（优势比[OR] 1.08；95%置信区间[CI] 0.96 - 1.21）、再次手术（OR 1.16；95% CI 0.96 - 1.40）或再入院（OR 1.14；95% CI 0.99 - 1.29）之间无显著关联。
在这些分析中，未发现同时进行的手术会增加不良结局的风险。这些结果并未减少进一步研究、持续自我监管以及向患者主动披露信息的必要性。
