Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
Sunnybrook Health Sciences Centre, Division of Orthopaedic Surgery, Toronto, Ontario, Canada.
JAMA Intern Med. 2018 Jan 1;178(1):75-83. doi: 10.1001/jamainternmed.2017.6835.
Overlapping surgery, also known as double-booking, refers to a controversial practice in which a single attending surgeon supervises 2 or more operations, in different operating rooms, at the same time.
To determine if overlapping surgery is associated with greater risk for complications following surgical treatment for hip fracture and arthritis.
DESIGN, SETTING, AND PARTICIPANTS: This was a retrospective population-based cohort study in Ontario, Canada (population, 13.6 million), for the years 2009 to 2014. There was 1 year of follow-up. This study encompassed 2 large cohorts. The "hip fracture" cohort captured all persons older than 60 years who underwent surgery for a hip fracture during the study period. The "total hip arthroplasty" (THA) cohort captured all primary elective THA recipients for arthritis during the study period. We matched overlapping and nonoverlapping hip fractures by patient age, patient sex, surgical procedure (for the hip fracture cohort), primary surgeon, and hospital.
Procedures were identified as overlapping if they overlapped with another surgical procedure performed by the same primary attending surgeon by more than 30 minutes.
Complication (infection, revision, dislocation) within 1 year.
There were 38 008 hip fractures, and of those, 960 (2.5%) were overlapping (mean age of patients, 66 years [interquartile range, 57-74 years]; 503 [52.4%] were female). There were 52 869 THAs and of those, 1560 (3.0%) overlapping (mean age, 84 years [interquartile range, 77-89 years]; 1293 [82.9%] were female). After matching, overlapping hip fracture procedures had a greater risk for a complication (hazard ratio [HR], 1.85; 95% CI, 1.27-2.71; P = .001), as did overlapping THA procedures (HR, 1.79; 95% CI, 1.02-3.14; P = .04). Among overlapping hip fracture operations, increasing duration of operative overlap was associated with increasing risk for complications (adjusted odds ratio, 1.07 per 10-minute increase in overlap; P = .009).
Overlapping surgery was relatively rare but was associated with an increased risk for surgical complications. Furthermore, increasing duration of operative overlap was associated with an increasing risk for complications. These findings support the notion that overlapping provision of surgery should be part of the informed consent process.
重叠手术，也称为双重预订，是指一种有争议的做法，即一名主治外科医生同时在不同的手术室监督 2 个或更多手术。
确定重叠手术是否与髋关节骨折和关节炎手术治疗后的并发症风险增加有关。
设计、地点和参与者：这是加拿大安大略省的一项回顾性基于人群的队列研究（人口 1360 万），时间为 2009 年至 2014 年。随访时间为 1 年。该研究包括 2 个大型队列。“髋关节骨折”队列纳入了所有在研究期间接受髋关节骨折手术的年龄大于 60 岁的患者。“全髋关节置换术”（THA）队列纳入了所有在研究期间接受原发性择期 THA 治疗关节炎的患者。我们通过患者年龄、患者性别、手术程序（对于髋关节骨折队列）、主刀医生和医院，将重叠和非重叠髋关节骨折进行匹配。
如果手术与同一位主治外科医生进行的另一个手术重叠超过 30 分钟，则将其确定为重叠。
1 年内出现并发症（感染、翻修、脱位）。
共 38008 例髋关节骨折，其中 960 例（2.5%）为重叠（患者平均年龄 66 岁[四分位距 57-74 岁]；503 例[52.4%]为女性）。共 52869 例 THA，其中 1560 例（3.0%）为重叠（平均年龄 84 岁[四分位距 77-89 岁]；1293 例[82.9%]为女性）。匹配后，重叠髋关节骨折手术的并发症风险更高（危险比[HR]，1.85；95%CI，1.27-2.71；P=0.001），重叠 THA 手术也是如此（HR，1.79；95%CI，1.02-3.14；P=0.04）。在重叠髋关节骨折手术中，手术重叠持续时间的增加与并发症风险的增加相关（调整后比值比，每增加 10 分钟重叠增加 1.07；P=0.009）。
重叠手术相对较少，但与手术并发症风险增加有关。此外，手术重叠时间的增加与并发症风险的增加有关。这些发现支持这样一种观点，即重叠手术的提供应作为知情同意过程的一部分。
