Overlapping Surgery in Orthopaedics: A Review of Efficacy, Surgical Costs, Surgical Outcomes, and Patient Safety

Abstract

Introduction: Overlapping surgery (OS) refers to when an attending surgeon supervises two surgeries at the same time with noncritical portions of both surgeries occurring simultaneously. Limited literature reviewing OS exists in orthopaedics. Our goal is to provide insight into this practice across orthopaedic subspecialities to inform its future utilization. Methods: A review of the literature was conducted after Preferred Reporting Items for Systematic Reviews and Meta-Analyses systematic review guidelines. All articles (630 total) were independently reviewed by two authors with a third to resolve discrepancies. Inclusion criteria encompassed any journal publication that included data on a series of orthopaedic OS. Data points sought included the type of surgery, quantity of cases, case duration, overlap time, perioperative complications, and cost. Results: Eleven articles met the inclusion criteria, encompassing a total of 34,494 overlapping surgeries. The studies varied regarding setting and subspecialties included. Six studies demonstrated increased surgical times for overlap cases. Two studies found that although OS increased cost per case, it improved the overall efficiency. Ten studies tracked short-term outcomes (<90 days) and reported no increase in complications with OS. Only one study examined long-term outcomes (1 year) and found a markedly increased risk for surgical complications with OS, with higher complication rates among nonelective compared with elective cases. Discussion: Current literature suggests that OS may increase surgical time, but from the 11 articles reviewed, only one demonstrates an increase in perioperative complications across orthopaedic subspecialities. OS also seems to increase costs per case; however, this is offset by the ability to perform more cases in the same period, resulting in an overall increase in the net profit. These data are consistent with studies from other surgical specialties. Conclusion: Although OS seems to be both safe and effective, future investigations are needed to understand the impact it has on patients and healthcare systems.