Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
McKenna EpiLog Fellowship in Population Health, University of Pennsylvania, Philadelphia, Pennsylvania.
Neurosurgery. 2019 Dec 1;85(6):E1050-E1058. doi: 10.1093/neuros/nyz243.
Limited data exist on the safety of overlapping surgery, a practice that has recently received widespread attention.
To examine the association of overlapping neurosurgery with patient outcomes.
A total of 3038 routinely scheduled, elective neurosurgical procedures were retrospectively reviewed at a single, multihospital academic medical center. Procedures were categorized into any overlap or no overlap and further subcategorized into beginning overlap (first 50% of procedure only), end overlap (last 50% of procedure only), and middle overlap (overlap at the midpoint).
A total of 1030 (33.9%) procedures had any overlap, whereas 278 (9.2%) had beginning overlap, 190 (6.3%) had end overlap, and 476 (15.7%) had middle overlap. Compared with no overlap patients, patients with any overlap had lower American Society of Anesthesiologists scores (P = .0018), less prior surgery (P < .0001), and less prior neurosurgery (P < .0001), though they tended to be older (P < .0001) and more likely in-patients (P = .0038). Any-overlap patients had decreased overall mortality (2.8% vs 4.5%; P = .025), 30- to 90-d readmission rate (3.1% vs 5.5%; P = .0034), 30- to 90-d reoperation rate (1.0% vs 2.0%; P = .03), 30- to 90-d emergency room (ER) visit rate (2.1% vs 3.7%; P = .018), and future surgery on index admission (2.8% vs 7.3%; P < .0001). Multiple regression analysis validated noninferior outcomes for overlapping surgery, except for the association of increased future surgery on index admission with middle overlap (odds ratio 3.99; 95% confidence interval [1.91, 8.33]).
Overlapping neurosurgery is associated with noninferior patient outcomes that may be driven by surgeon selection of healthier patients, regardless of specific overlap timing.
重叠手术的安全性数据有限，这种做法最近受到了广泛关注。
研究重叠神经外科手术与患者预后的关系。
在一家多医院的学术医疗中心，回顾性分析了 3038 例常规择期神经外科手术。手术分为有重叠和无重叠，并进一步细分为开始重叠（仅前 50%的手术）、结束重叠（仅后 50%的手术）和中间重叠（手术中点重叠）。
共有 1030 例（33.9%）手术存在任何重叠，其中 278 例（9.2%）有开始重叠，190 例（6.3%）有结束重叠，476 例（15.7%）有中间重叠。与无重叠患者相比，有重叠的患者美国麻醉医师协会评分较低（P=0.0018），先前手术较少（P<0.0001），先前神经外科手术较少（P<0.0001），但年龄较大（P<0.0001），更有可能是住院患者（P=0.0038）。有重叠的患者总体死亡率（2.8%比 4.5%；P=0.025）、30-90 天再入院率（3.1%比 5.5%；P=0.0034）、30-90 天再手术率（1.0%比 2.0%；P=0.03）、30-90 天急诊就诊率（2.1%比 3.7%；P=0.018）和指数入院时的未来手术率（2.8%比 7.3%；P<0.0001）均降低。多变量回归分析验证了重叠手术的非劣效性结果，但与中间重叠增加指数入院时未来手术的关联除外（优势比 3.99；95%置信区间 [1.91，8.33]）。
重叠神经外科手术与非劣效的患者预后相关，这可能是由于外科医生选择了更健康的患者，而与具体的重叠时间无关。
