Study: Having More than One Outpatient Orthopedic Procedure in A Day Is Safe

By Jane Farrell

Having more than one outpatient orthopedic procedure on the same day is safe for patients, according to a new study.

The findings were reported in the December 19,2018 issue of the The Journal of Bone and Joint Surgery.

“Our data suggest that briefly overlapping surgery is a safe practice in the ambulatory orthopedic surgery center,” said lead author Charles A. Goldfarb, MD, of Washington University School of Medicine, St. Louis.

Overlapping surgery is used to increase the efficiency of operating rooms.

Goldfarb and colleagues compared the outcomes of overlapping versus nonoverlapping surgery at their university-affiliated orthopedic ambulatory surgical center (ASC). In overlapping surgery, the attending surgeon is present for “critical” parts of the procedure, leaving another surgeon to perform noncritical portions – typically skin closure. Overlapping surgery is commonly used to maximize operating room efficiency. According to this ASC’s policy, another attending surgeon -not a resident or fellow in training – was present during the overlapping portion of the procedure.

Although this practice is not new, it has become controversial in the wake of recent high-profile media reports. Most previous studies of overlapping surgery have focused on inpatient procedures, performed on hospitalized patients.

The analysis included more than 22,000 outpatient orthopedic procedures performed between 2009 and 2015. The patients underwent a wide range of elective surgeries, including knee, hand, and shoulder procedures. No joint replacement or spine operations were included in the analysis.

The overall complication rate (morbidity) was 0.66 percent in the overlapping surgery group and 0.54 percent in the nonoverlapping surgery group. After the authors adjusted for other factors, the morbidity risk was not significantly different between groups. The same was true for all individual complications considered: surgical site infections, noninfection surgical complications, and transfer to an inpatient hospital.

Anesthesia and overall surgery times were slightly longer in the overlapping surgery group, but these surgical factors did not increase the risk of complications.

The researchers noted that although this study includes a large number of outpatient orthopedic surgery cases, the statistics represent the experience of only one surgical center. Nevertheless, the results suggest that overlapping orthopedic surgery can be safely carried out in ambulatory surgery settings – at least as practiced at the authors’ institution.