Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
McKenna EpiLog Fellowship in Population Health, at the University of Pennsylvania, Philadelphia, PA.
Ann Surg. 2019 Oct;270(4):620-629. doi: 10.1097/SLA.0000000000003494.
Assess the safety of overlapping surgery before implementation of new recommendations and regulations.
Overlapping surgery is a longstanding practice that has not been well studied. There remains a need to analyze data across institutions and specialties to draw well-informed conclusions regarding appropriate application of this practice.
Coarsened exact matching was used to assess the impact of overlap on outcomes amongst all surgical interventions (n = 61,524) over 1 year (2014) at 1 health system. Overlap was categorized as: any, beginning, or end overlap. Study subjects were matched 1:1 on 11 variables. Serious unanticipated events were studied including unplanned return to operating room, readmission, and mortality.
In all, 8391 patients (13.6%) had any overlap and underwent coarsened exact matching. For beginning/end overlap, matched groups were created (total matched population N = 4534/3616 patients, respectively). Any overlap did not predict unanticipated return to surgery (9.8% any overlap vs 10.1% no overlap; P = 0.45). Further, any overlap did not predict an increase in reoperation, readmission, or emergency room (ER) visits at 30 or 90 days (30D reoperation 3.6% vs 3.7%; P = 0.83, 90D reoperation 3.8% vs 3.9%; P = 0.84) (30D readmission 9.9% vs 10.2%; P = 0.45, 90D readmissions 6.9% vs 7.0%; P = 0.90) (30D ER 5.4% vs 5.6%; P = 0.60, 90D ER 4.8% vs 4.7%; P = 0.71). In addition, any overlap was not associated with mortality over the surgical follow-up period (90D mortality 1.7% vs 2.1%; P = 0.06). Beginning/end overlap had results similar to any overlap.
Overlapping, nonconcurrent surgery is not associated with an increase in reoperation, readmission, ER visits, or unanticipated return to surgery.
评估新建议和规定实施前重叠手术的安全性。
重叠手术是一种由来已久的做法，尚未得到充分研究。仍有必要跨机构和专业分析数据，以就该实践的适当应用得出明智的结论。
在一个医疗系统中，使用粗略精确匹配来评估 1 年内（2014 年）所有手术干预（n = 61524）中重叠对结果的影响。重叠分为：任何、开始或结束重叠。研究对象根据 11 个变量进行 1:1 匹配。研究了严重的意外事件，包括计划外返回手术室、再入院和死亡率。
共有 8391 名患者（13.6%）存在任何重叠并接受了粗略精确匹配。对于开始/结束重叠，创建了匹配组（总匹配人群 N = 4534/3616 名患者）。任何重叠均不会预测意外再次手术（任何重叠的 9.8%与无重叠的 10.1%；P = 0.45）。此外，任何重叠均不会增加 30 天或 90 天的再次手术、再入院或急诊就诊（30 天再次手术 3.6%比 3.7%；P = 0.83，90 天再次手术 3.8%比 3.9%；P = 0.84）（30 天再入院 9.9%比 10.2%；P = 0.45，90 天再入院 6.9%比 7.0%；P = 0.90）（30 天急诊就诊 5.4%比 5.6%；P = 0.60，90 天急诊就诊 4.8%比 4.7%；P = 0.71）。此外，在手术随访期间，任何重叠均与死亡率无关（90 天死亡率 1.7%比 2.1%；P = 0.06）。开始/结束重叠的结果与任何重叠相似。
非同时进行的重叠手术不会增加再次手术、再入院、急诊就诊或意外再次手术的风险。
