Department of Neurosurgery, Hospital of the University of Pennsylvania, Perelman School of Medicine, University of Philadelphia, Philadelphia, Pennsylvania.
McKenna EpiLog Fellowship in Population Health, University of Pennsylvania, Philadelphia, Pennsylvania.
Neurosurgery. 2019 Nov 1;85(5):E882-E888. doi: 10.1093/neuros/nyz142.
Several studies have explored the effect of overlapping surgery on patient outcomes, but impact of surgical overlap during wound closure has not been studied.
To examine the association of overlap during wound closure and suture time overlap (STO) with patient outcomes in a heterogeneous neurosurgical population.
Over 4 yr (7/2013-7/2017), 1 7689 neurosurgical procedures were retrospectively reviewed at a single, multihospital academic medical center. STO was defined as all surgeries for which an overlapping surgery occurred, exclusively, during wound closure of the index case being studied. We excluded nonelective cases and overlapping surgeries that involved overlap during surgical portions of the case other than wound closure. Tests of independence and Wilcoxon tests were used for statistical analysis.
Patients with STO had a shortened length of hospital stay (100.6 vs 135.1 h; P < .0001), reduced deaths in follow-up (1.59% vs 5.45%; P = .0004), and lower 30- to 90-d readmission rates (3.64% vs 7.47%; P = .0026). Patients with STO had no increase in revision surgery. Patients with STO had longer wound closure times (26.5 vs 23.9 min; P < .0001) but shorter total surgical times (nonclosure surgical time 101.8 vs 133.3 min; P < .0001; and total surgical time 128.3 vs 157.1 min; P < .0001).
Surgical overlap during wound closure (STO) is associated with improved or at least noninferior patient outcomes, as it pertains to readmissions and wound revisions.
已有多项研究探讨了重叠手术对患者结局的影响，但尚未研究在伤口缝合过程中手术重叠的影响。
在一个异质的神经外科人群中，研究伤口缝合过程中的重叠与缝合时间重叠（STO）与患者结局的关系。
在一个单中心多医院的学术医疗中心，回顾性分析了超过 4 年（2013 年 7 月至 2017 年 7 月）的 17689 例神经外科手术。STO 定义为所有在研究对象的指数病例的伤口缝合过程中发生的重叠手术。我们排除了非选择性病例和涉及手术过程中除伤口缝合以外的重叠手术的重叠手术。采用独立性检验和 Wilcoxon 检验进行统计学分析。
STO 患者的住院时间更短（100.6 小时 vs. 135.1 小时；P < 0.0001），随访期间的死亡率更低（1.59% vs. 5.45%；P = 0.0004），30 至 90 天再入院率更低（3.64% vs. 7.47%；P = 0.0026）。STO 患者的修正手术没有增加。STO 患者的伤口闭合时间更长（26.5 分钟 vs. 23.9 分钟；P < 0.0001），但总手术时间更短（非闭合手术时间 101.8 分钟 vs. 133.3 分钟；P < 0.0001；总手术时间 128.3 分钟 vs. 157.1 分钟；P < 0.0001）。
在伤口缝合过程中发生的手术重叠（STO）与改善或至少非劣效的患者结局相关，就再入院和伤口修正而言。
