Comparison of Patient Outcomes in 3725 Overlapping vs 3633 Nonoverlapping Neurosurgical Procedures Using a Single Institution's Clinical and Administrative Database

Authors

Corinna C. Zygourakis, Department of Neurological Surgery , University of California, San Francisco, California, USA.
Malla Keefe, Department of Neurological Surgery , University of California, San Francisco, California, USA.
Janelle Lee, Department of Quality, UCSF Health, University of California, San Francisco, California, USA.
Julio Barba, Department of Quality, UCSF Health, University of California, San Francisco, California, USA.
Michael W. McDermott, Department of Neurological Surgery , University of California, San Francisco, California, USA.
Praveen V. Mummaneni, Department of Neurological Surgery , University of California, San Francisco, California, USA.
Michael T. Lawton, Department of Neurological Surgery , University of California, San Francisco, California, USA.Follow

Document Type

Article

Abstract

Background: Overlapping surgery is a common practice to improve surgical efficiency, but there are limited data on its safety. Objective: To analyze the patient outcomes of overlapping vs nonoverlapping surgeries performed by multiple neurosurgeons. Methods: Retrospective review of 7358 neurosurgical procedures, 2012 to 2015, at an urban academic hospital. Collected variables: patient age, gender, insurance, American Society of Anesthesiologists score, severity of illness, mortality risk, admission type, transfer source, procedure type, surgery date, number of cosurgeons, presence of neurosurgery resident/fellow/another attending, and overlapping vs nonoverlapping surgery. Outcomes: procedure time, length of stay, estimated blood loss, discharge location, 30-day mortality, 30-day readmission, return to operating room, acute respiratory failure, and severe sepsis. Statistics: univariate, then multivariate mixed-effect models. Results: Overlapping surgery patients (n = 3725) were younger and had lower American Society of Anesthesiologists scores, severity of illness, and mortality risk (P < .0001) than nonoverlapping surgery patients (n = 3633). Overlapping surgeries had longer procedure times (214 vs 172 min; P < .0001), but shorter length of stay (7.3 vs 7.9 d; P = .010) and lower estimated blood loss (312 vs 363 mL’s; P = .003). Overlapping surgery patients were more likely to be discharged home (73.6% vs 66.2%; P < .0001), and had lower mortality rates (1.3% vs 2.5%; P = .0005) and acute respiratory failure (1.8% vs 2.6%; P = .021). In multivariate models, there was no significant difference between overlapping and nonoverlapping surgeries for any patient outcomes, except for procedure duration, which was longer in overlapping surgery (estimate = 23.03; P < .001). Conclusions: When planned appropriately, overlapping surgery can be performed safely within the infrastructure at our academic institution.

Medical Subject Headings

Hospitalization (statistics & numerical data); Humans; Neurosurgical Procedures (adverse effects, methods, statistics & numerical data); Postoperative Complications; Retrospective Studies; Treatment Outcome

Publication Date

2-9-2017

Publication Title

Neurosurgery

E-ISSN

1524-4040

Volume

80

Issue

2

First Page

257

Last Page

268

PubMed ID

28173545

Digital Object Identifier (DOI)

10.1093/neuros/nyw067

Recommended Citation

Zygourakis, Corinna C.; Keefe, Malla; Lee, Janelle; Barba, Julio; McDermott, Michael W.; Mummaneni, Praveen V.; and Lawton, Michael T., "Comparison of Patient Outcomes in 3725 Overlapping vs 3633 Nonoverlapping Neurosurgical Procedures Using a Single Institution's Clinical and Administrative Database" (2017). Neurosurgery. 1178.
https://scholar.barrowneuro.org/neurosurgery/1178