TY - JOUR
T1 - Outcomes of Concurrent Operations
T2 - Results from the American College of Surgeons' National Surgical Quality Improvement Program
AU - Liu, Jason B.
AU - Berian, Julia R.
AU - Ban, Kristen A.
AU - Liu, Yaoming
AU - Cohen, Mark E.
AU - Angelos, Peter
AU - Matthews, Jeffrey B.
AU - Hoyt, David B.
AU - Hall, Bruce L.
AU - Ko, Clifford Y.
N1 - Funding Information:
Disclosures: J.L. is supported by a research fellowship from the Department of Surgery, University of Chicago Medicine, under the auspices of J.B.M., and the American College of Surgeons’ Clinical Scholars in Residence Program. K.A.B. is supported by a research fellowship from the Department of Surgery, Loyola University Medical Center and the American College of Surgeons’ Clinical Scholars in Residence Program. J.R.B. is supported by the John A. Hartford Foundation and the American College of Surgeons’ Clinical Scholars in Residence Program.
Publisher Copyright:
© 2017 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2017/9/1
Y1 - 2017/9/1
N2 - Objective: To determine whether concurrently performed operations are associated with an increased risk for adverse events. Background: Concurrent operations occur when a surgeon is simultaneously responsible for critical portions of 2 or more operations. How this practice affects patient outcomes is unknown. Methods: Using American College of Surgeons' National Surgical Quality Improvement Program data from 2014 to 2015, operations were considered concurrent if they overlapped by ≥60 minutes or in their entirety. Propensity-score-matched cohorts were constructed to compare death or serious morbidity (DSM), unplanned reoperation, and unplanned readmission in concurrent versus non-concurrent operations. Multilevel hierarchical regression was used to account for the clustered nature of the data while controlling for procedure and case mix. Results: There were 1430 (32.3%) surgeons from 390 (77.7%) hospitals who performed 12,010 (2.3%) concurrent operations. Plastic surgery (n = 393 [13.7%]), otolaryngology (n = 470 [11.2%]), and neurosurgery (n = 2067 [8.4%]) were specialties with the highest proportion of concurrent operations. Spine procedures were the most frequent concurrent procedures overall (n = 2059/12,010 [17.1%]). Unadjusted rates of DSM (9.0% vs 7.1%; P < 0.001), reoperation (3.6% vs 2.7%; P < 0.001), and readmission (6.9% vs 5.1%; P < 0.001) were greater in the concurrent operation cohort versus the non-concurrent. After propensity score matching and risk-adjustment, there was no significant association of concurrence with DSM (odds ratio [OR] 1.08; 95% confidence interval [CI] 0.96-1.21), reoperation (OR 1.16; 95% CI 0.96-1.40), or readmission (OR 1.14; 95% CI 0.99-1.29). Conclusions: In these analyses, concurrent operations were not detected to increase the risk for adverse outcomes. These results do not lessen the need for further studies, continuous self-regulation and proactive disclosure to patients.
AB - Objective: To determine whether concurrently performed operations are associated with an increased risk for adverse events. Background: Concurrent operations occur when a surgeon is simultaneously responsible for critical portions of 2 or more operations. How this practice affects patient outcomes is unknown. Methods: Using American College of Surgeons' National Surgical Quality Improvement Program data from 2014 to 2015, operations were considered concurrent if they overlapped by ≥60 minutes or in their entirety. Propensity-score-matched cohorts were constructed to compare death or serious morbidity (DSM), unplanned reoperation, and unplanned readmission in concurrent versus non-concurrent operations. Multilevel hierarchical regression was used to account for the clustered nature of the data while controlling for procedure and case mix. Results: There were 1430 (32.3%) surgeons from 390 (77.7%) hospitals who performed 12,010 (2.3%) concurrent operations. Plastic surgery (n = 393 [13.7%]), otolaryngology (n = 470 [11.2%]), and neurosurgery (n = 2067 [8.4%]) were specialties with the highest proportion of concurrent operations. Spine procedures were the most frequent concurrent procedures overall (n = 2059/12,010 [17.1%]). Unadjusted rates of DSM (9.0% vs 7.1%; P < 0.001), reoperation (3.6% vs 2.7%; P < 0.001), and readmission (6.9% vs 5.1%; P < 0.001) were greater in the concurrent operation cohort versus the non-concurrent. After propensity score matching and risk-adjustment, there was no significant association of concurrence with DSM (odds ratio [OR] 1.08; 95% confidence interval [CI] 0.96-1.21), reoperation (OR 1.16; 95% CI 0.96-1.40), or readmission (OR 1.14; 95% CI 0.99-1.29). Conclusions: In these analyses, concurrent operations were not detected to increase the risk for adverse outcomes. These results do not lessen the need for further studies, continuous self-regulation and proactive disclosure to patients.
KW - American College of Surgeons' National Surgical Quality Improvement Program
KW - concurrent surgery
KW - outcomes
KW - overlapping surgery
UR - http://www.scopus.com/inward/record.url?scp=85021291703&partnerID=8YFLogxK
U2 - 10.1097/SLA.0000000000002358
DO - 10.1097/SLA.0000000000002358
M3 - Article
C2 - 28650359
AN - SCOPUS:85021291703
SN - 0003-4932
VL - 266
SP - 411
EP - 420
JO - Annals of Surgery
JF - Annals of Surgery
IS - 3
ER -