Overlapping Surgeries Worsens Outcomes in Hip Surgery Patients

Although overlapping surgery is somewhat rare, it increases the risk of surgical complications among individuals who receive a hip fracture procedure, according to a recent study.

Overlapping surgery, or double-booking, occurs when a single attending surgeon simultaneously supervises 2 or more surgeries in different operating rooms. This practice is considered controversial.
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From 2009 to 2014, the researchers retrospectively evaluated 2 large cohorts of surgery recipients in Ontario, Canada. Members of the “hip fracture” cohort included participants age 60 years or older who had undergone surgery for a hip fracture (mean age: 66 years), while the “total hip arthroplasty” (THA) cohort included primary elective THA recipients for arthritis (mean age: 84 years).

The researchers defined the mean outcome as 1-year complications from surgery including infection, revision, and dislocation. Overlapping and nonoverlapping hip fractures were matched based on patient age, sex, and other factors.

Ultimately, there were 30,008 hip fracture procedures, of which 960 (2.5%) were overlapping, as well as 56,869 THAs, of which 1560 (3.0%) were overlapping. Results revealed that overlapping hip fracture procedures carries a higher risk for surgical complication (hazard ratio [HR] 1.85) vs overlapping THA procedures (HR 1.79).

An increasing duration of operative overlap among overlapping hip fracture operations was found to be associated with an increased risk for complication (adjusted odds ratio 1.07 per 10-minute increase in overlap).

“Overlapping surgery was relatively rare but was associated with an increased risk for surgical complications,” the researchers concluded. “Furthermore, increasing duration of operative overlap was associated with an increasing risk for complications. These findings support the notion that overlapping provision of surgery should be part of the informed consent process.”

—Christina Vogt

Reference:

Ravi B, Pincus D, Wasserstein D, et al. Association of overlapping surgery with increased risk for complications following hip surgery: a population-based, matched cohort study. JAMA Intern Med. 2018;178(1):75-83. doi:10.1001/jamainternmed.2017.6835.