Does Overlapping Surgery Result in Worse Surgical Outcomes? A Systematic Review and Meta-Analysis
*Rajshri Mainthia-Gartland1, *Kristin Alves2, *Níssia Brasil3, *Matthew Mossanen4, *Elizabeth Mort5, *Cameron D Wright1, *Carrie C Lubitz1, *Collin May6
1Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA;2Department of Orthopedic Surgery, Harvard Medical School, Boston, MA;3Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA;4Department of Surgery, Division of Urology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA;5Lawrence Center for Quality and Safety, Massachusetts General Hospital and Massachusetts General Physicians’ Organization, Boston, MA;6Department of Orthopedic Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, MA
Objective: The impact of overlapping surgery on patient outcomes has important implications to patient safety, clinical outcomes, and healthcare costs. While several studies have examined the relationship of overlapping surgery and various clinical outcomes, a combined analysis of available data has not been performed. The aim of the study was to evaluate the impact of overlapping surgery on 30-day mortality, morbidity, and length of surgery.
Design: Systematic review and meta-analysis
Setting and Patients: Studies examining outcomes of patients who underwent overlapping versus non-overlapping surgery were included. Studies that examined concurrent surgery, included duplicate data, and/or included data exclusively from an ambulatory surgery center or children’s hospital were excluded.
Interventions: A systematic literature review was performed using PubMed, MEDLINE via OVID, and EMBASE to capture all relevant studies as of March 2018. A manual search of references from these articles was also performed. A pooled meta-analysis of the final selection of studies was performed using fixed- and random-effects models. Heterogeneity and publication bias were assessed and subgroup analysis was performed using quality score.
Main Outcome Measures: 30-day mortality, morbidity, and length of surgery
Results: A total of 11 retrospective cohort studies with 14 sets of analyses met inclusion and exclusion criteria. Meta-analysis demonstrated no significant differences in 30-day mortality (OR=0.84; p=0.277) or overall morbidity (OR=0.96; p=0.632) between patients who underwent overlapping versus non-overlapping surgery. The standardized mean difference (SMD) for length of surgery between the groups indicated a small statistically significant increase in length of surgery for the overlapping surgery group (SMD=0.079, p<0.05).
Conclusion: While further study is warranted, current literature suggests that overlapping surgery is not associated with increased risk of mortality or morbidity.
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