Department of Orthopaedic Surgery, Washington University School of Medicine and Barnes Jewish Hospital, St. Louis, Missouri.
J Bone Joint Surg Am. 2018 Dec 19;100(24):2118-2124. doi: 10.2106/JBJS.18.00244.
Overlapping surgery occurs when a single surgeon is the primary surgeon for >1 patient in separate operating rooms simultaneously. The surgeon is present for the critical portions of each patient's operation although not present for the entirety of the case. While overlapping surgery has been widely utilized across surgical subspecialties, few large studies have compared the safety of overlapping and nonoverlapping surgery.
In this retrospective cohort study, we reviewed the charts of patients who had undergone orthopaedic surgery at our ambulatory surgery center during the period of April 2009 and October 2015. A database of operations, including patient and surgical characteristics, was compiled. Complications had been identified and logged into the database by surgeons monthly over the study period. These monthly reports and case logs were reviewed retrospectively to identify complications. Propensity-score weighting and logistic regression models were used to determine the association between outcomes and overlapping surgery.
A total of 22,220 operations were included. Of these, 5,198 (23%) were overlapping, and 17,022 (77%) were nonoverlapping. The median duration of surgery overlap was 8 minutes (quartile 1 to quartile 3, 3 to 16 minutes); no operations were concurrent. After weighting, the only continuous variables that differed significantly between the groups were operative time (median, 57 compared with 56 minutes for the overlapping and the nonoverlapping group, respectively; p = 0.022), anesthesia time (median, 97 compared with 93 minutes; p < 0.001), and total tourniquet time (median, 26 compared with 22 minutes; p = 0.0093). Multivariable logistic regression models did not demonstrate an association between overlapping surgery and surgical site infection, noninfection surgical complications, hospitalization, or morbidity.
These data suggest that there is no association between briefly overlapping surgery and surgical site infection, noninfection surgical complications, hospitalization, and morbidity. When practiced in the manner described herein, overlapping orthopaedic surgery can be a safe practice in the ambulatory setting.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
当一名外科医生同时在两个不同的手术室为超过 1 名患者担任主刀医生时，就会发生重叠手术。外科医生会出现在每位患者手术的关键部分，但不会全程参与手术。虽然重叠手术已经在多个外科专业中广泛应用，但很少有大型研究比较重叠手术和非重叠手术的安全性。
在这项回顾性队列研究中，我们查阅了 2009 年 4 月至 2015 年 10 月期间在我们日间手术中心接受骨科手术的患者的病历。我们编制了一个包含手术患者和手术特征的数据库。在研究期间，外科医生每月将并发症识别并记录到数据库中。我们回顾性地审查这些每月报告和病例记录，以识别并发症。我们使用倾向评分加权和逻辑回归模型来确定结果与重叠手术之间的关联。
共纳入 22220 例手术。其中，5198 例（23%）为重叠手术，17022 例（77%）为非重叠手术。手术重叠的中位时间为 8 分钟（四分位间距 1 到 4，3 到 16 分钟）；没有同时进行的手术。在加权后，两组之间唯一存在显著差异的连续变量是手术时间（中位数，分别为 57 分钟和 56 分钟；p = 0.022）、麻醉时间（中位数，分别为 97 分钟和 93 分钟；p < 0.001）和总止血带时间（中位数，分别为 26 分钟和 22 分钟；p = 0.0093）。多变量逻辑回归模型并未显示重叠手术与手术部位感染、非感染性手术并发症、住院和发病率之间存在关联。
这些数据表明，短暂重叠手术与手术部位感染、非感染性手术并发症、住院和发病率之间没有关联。当以本文所述的方式实施时，重叠骨科手术在日间手术环境中是一种安全的做法。
治疗性 III 级。有关证据水平的完整说明，请参见作者说明。
