Department of Anesthesiology, Mayo Clinic, Rochester, MN.
Robert D and Patricia E Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN.
Ann Surg. 2018 Aug;268(2):e24-e27. doi: 10.1097/SLA.0000000000002682.
Media reports have questioned the safety of overlapping surgical procedures, and national scrutiny has underscored the necessity of single-center evaluations of its safety; however, sample sizes are likely small. We compared the safety profiles of overlapping and nonoverlapping pediatric procedures at a single children's hospital and discussed methodological considerations of the evaluation.
Retrospective analysis of inpatient pediatric surgical procedures (January 2013 to September 2015) at a single pediatric referral center. Overlapping and nonoverlapping procedures were matched in an unbalanced manner (m:n) by procedure. Mixed models adjusting for Vizient-predicted risk, case-mix, and surgeon compared inpatient mortality and length of stay (LOS).
Among 315 overlapping procedures, 256 (81.3%) were matched to 645 nonoverlapping procedures. There were 6 deaths in all. The adjusted odds ratio for mortality did not differ significantly between nonoverlapping and overlapping procedures (adjusted odds ratio = 0.94 vs overlapping; 95% CI, 0.02-48.5; P = 0.98). Wide confidence intervals were minimally improved with Bayesian methods (95% CI, 0.07-12.5). Adjusted LOS estimates were not clinically different by overlapping status (0.6% longer for nonoverlapping; 95% CI, 9.7% shorter to 12.2% longer; P = 0.91). Among the 87 overlapping procedures with the greatest overlap (≥60 min or ≥50% of operative duration), there were no deaths.
The safety of overlapping and nonoverlapping surgical procedures did not differ at this children's center. These findings may not extrapolate to other centers. LOS or intraoperative measures may be more appropriate than mortality for safety evaluations due to low event rates for mortality.
媒体报道对重叠手术的安全性提出了质疑，国家审查强调了对其安全性进行单中心评估的必要性；然而，样本量可能很小。我们比较了一家儿童医院重叠和非重叠儿科手术的安全性，并讨论了评估的方法学考虑。
对一家儿童医院的住院儿科手术（2013 年 1 月至 2015 年 9 月）进行回顾性分析。通过手术以不平衡的方式（m:n）将重叠和非重叠手术进行匹配。混合模型调整了 Vizient 预测的风险、病例组合和外科医生，比较了住院死亡率和住院时间（LOS）。
在 315 例重叠手术中，256 例（81.3%）与 645 例非重叠手术相匹配。所有患者中共有 6 例死亡。非重叠和重叠手术的死亡率调整比值比无显著差异（调整比值比=0.94 比重叠；95%CI，0.02-48.5；P=0.98）。贝叶斯方法略微改善了置信区间（95%CI，0.07-12.5）。重叠状态下的调整 LOS 估计值没有明显差异（非重叠组长 0.6%；95%CI，9.7%短至 12.2%长；P=0.91）。在 87 例重叠时间最长（≥60 分钟或手术时间≥50%）的重叠手术中，没有死亡。
在这家儿童医院，重叠和非重叠手术的安全性没有差异。这些发现可能不适用于其他中心。由于死亡率的事件率较低，LOS 或术中测量可能比死亡率更适合安全性评估。
