Public Release: 

Does overlapping surgery increase complication risk after hip surgery?

The JAMA Network Journals

Bottom Line: The practice of a single surgeon supervising two surgeries in different operating rooms at the same time was associated with increased risk for complications after hip surgery, although the practice of overlapping surgery was uncommon.

Why The Research Is Interesting: Overlapping surgery has come under scrutiny recently with questions raised about the quality of the practice and issues over informed consent from patients when a surgeon supervises multiple procedures. Concerns about overlapping surgery were summarized in recent JAMA and JAMA Surgery articles and include inadequate informed patient consent, compromised patient safety, and medical ethics. There is little evidence to support or refute these concerns.

Who and When: Two large patient groups in Ontario, Canada: patients older than 60 who had hip fracture surgery from 2009 to 2014 and patients over 40 who had elective total hip replacement for arthritis from 2009 to 2015.

What: Hip surgery overlapping with another surgical procedure by more than 30 minutes and performed by the same primary attending surgeon (exposure); complications of infection, hip dislocation and surgical revision within one year (outcome). Patients who had hip surgery that overlapped with another procedure were compared with patients who had the same surgical procedure by the same surgeon without an overlapping procedure.

How (Study Design): A population-based study using administrative patient data. A population-based study describes characteristics of health and disease in one or more large populations, typically without detailed information about underlying causes.

Authors: Bheeshma Ravi, M.D., Ph.D., of Sunnybrook Health Sciences Centre, Toronto, Canada, and coauthors

Results: While overlapping surgery was uncommon, it was associated with an increased risk for complications in hip surgery, especially in a nonelective procedure for hip fracture. The risk appeared to increase along with the duration of the surgical overlap.

Study Limitations: Overlapping hip fracture surgery was relatively uncommon so the results may not be generalizable to hospitals where overlapping surgical procedures are more common and not generalizable to other surgical procedures.

Study Conclusions: Findings support including the possibility that a surgeon will supervise overlapping surgeries as part of the informed patient consent process.

Related Material: The commentary, "Overlapping Surgery-Perspective From the Other Side of the Table," by Alan L. Zhang, M.D., of the University of California, San Francisco

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For more details and to read the full study, please visit the For The Media website.

(doi:10.1001/jamainternmed.2017.6835)

Editor's Note: The article contains funding/support disclosures. Please see the article for additional information.

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