Impact of the Percentage of Overlapping Surgery on Patient Outcomes: A Retrospective Cohort Study of 87,000 Surgical Cases.

OBJECTIVES: The primary objective of this study was to analyze the relationship of percentage of surgical overlap with patient outcomes to determine if a detrimental level of overlap exists. BACKGROUND: Overlapping surgery is defined as 1 attending physician supervising 2 or more operative cases simultaneously, without the critical portions of the cases occurring concurrently. To date, no study has examined the relationship of percent overlap, or the percentage of 1 case that is spent overlapping with another, to outcomes, efficiency, safety, and complications. METHODS: This study is a retrospective cohort study conducted at a large tertiary referral center. The primary outcomes of interest included operative duration, in-hospital mortality, 30-day readmission, and patient safety indicators (PSIs). The Cochran-Armitage test for trend was used to evaluate the outcomes of interest. P values of ≤0.05 were considered statistically significant. RESULTS: A total of 87,426 cases were included in this study. There were 62,332 cases without overlap (Group 0), 10,514 cases with 1% to 25% overlap (Group 1), 5303 cases with 26% to 50% overlap (Group 2), 4296 cases with 51% to 75% overlap (Group 3), and 4981 cases with >75% overlap (Group 4). In-hospital mortality decreased as overlap increased ( Ptrend <0.0001). Operative time increased with increasing overlap ( Ptrend <0.0001) while readmission rates showed no statistical significance between groups ( Ptrend =0.5078). Rates of PSIs were lower for Groups 1, 2, and 3 (1.69%, 2.01%, and 2.08%) when compared to Group 0 (2.24%). Group 4 had the highest rate of PSIs at 2.35% ( P =0.0086). CONCLUSION: Overlapping surgery was shown to have reduced in-hospital mortality and similar PSI and readmission rates when compared to nonoverlapping cases. Operative time was shown to increase in overlapping surgeries when compared to nonoverlapping surgeries. The results from this study indicate that the percentage of surgical overlap does not detrimentally affect most patient outcomes, especially with overlap of <75%.

Comparison of severe injuries between powered and nonpowered scooters among children aged 2 to 12 in the United States.

OBJECTIVE: A substantial increase in the number of nonpowered and powered scooter injuries since 2000 has occurred in the United States. Because of differences in weight and operational speed between scooter types, it is possible that the type and severity of injuries may differ. The purpose of the current study is to compare demographics and injury characteristics between scooter types, focusing on differences in injury severity. METHODS: The 2002-2006 National Electronic Injury Surveillance System provided information about individuals aged 2 to 12 years who sought treatment at an emergency department due to powered or nonpowered scooter-related injury in the United States. We defined severe injury as an injury resulting in the hospitalization, staying in the hospital for observation, or transfer of the injured patient. Logistic regression analysis, adjusted for sex, age, and geographic location in which the injury occurred, estimated odds ratios (ORs) and 95% confidence intervals (CI) for the association between scooter type and severe injury. RESULTS: There were an estimated 15 752 and 185 007 injuries related to powered and nonpowered scooters, respectively. Powered scooter-related injuries were over 3 times as likely to be severe (OR 3.57, 95% CI, 1.91-6.65). This association was more prominent among females (OR 5.80, 95% CI, 2.02-16.63) than males (OR 2.90, 95% CI, 1.44-5.82). CONCLUSION: Data suggest that, compared with nonpowered scooter-related injuries, powered scooter-related injuries are more often severe. This association is stronger among females than males. The higher risk of severe injury due to powered scooter use could result from increases in concussions and hip and lower extremity injuries.