Outcomes of Concurrent Operations: Results from the American College of Surgeons' National Surgical Quality Improvement Program

Jason B. Liu, Julia R. Berian, Kristen A. Ban, Yaoming Liu, Mark E. Cohen, Peter Angelos, Jeffrey B. Matthews, David B. Hoyt, Bruce L. Hall, Clifford Y. Ko

Research output: Contribution to journalArticlepeer-review

23 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)411-420
Number of pages10
JournalAnnals of surgery
Volume266
Issue number3
DOIs
StatePublished - Sep 1 2017

Bibliographical note

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.

Keywords

  • American College of Surgeons' National Surgical Quality Improvement Program
  • concurrent surgery
  • outcomes
  • overlapping surgery

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