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11 tweets,
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Who's doing your surgery?
Our new @JAMA_current study on the controversial practice of overlapping surgery & what it means for patients (led by @StanfordMed Eric Sun), using data on ~66,000 surgeries performed at 8 medical centers. Thread on findings
ja.ma/2EhwXlC
Our new @JAMA_current study on the controversial practice of overlapping surgery & what it means for patients (led by @StanfordMed Eric Sun), using data on ~66,000 surgeries performed at 8 medical centers. Thread on findings
ja.ma/2EhwXlC
2/x
Overlapping surgery is when the start of an operation being conducted by a surgeon occurs before the end of previous surgery the surgeon was involved in. Concurrent surgery, which is a subset of overlapping surgery, is when critical portions of a surgery overlap.
Overlapping surgery is when the start of an operation being conducted by a surgeon occurs before the end of previous surgery the surgeon was involved in. Concurrent surgery, which is a subset of overlapping surgery, is when critical portions of a surgery overlap.
3/x
It's probably obvious why this could be a risky practice. The practice was brought to the national spotlight by @BostonGlobe and @seattletimes descriptions of this practice at area hospitals.
It's probably obvious why this could be a risky practice. The practice was brought to the national spotlight by @BostonGlobe and @seattletimes descriptions of this practice at area hospitals.
4/x
Counter is that ORs are costly, surgery wait times are long, & surgical trainees need to learn how to perform independently (this gives them that chance). Prior studies find mixed results on outcomes, but most negative. Limitations include single center and limited surgeries.
Counter is that ORs are costly, surgery wait times are long, & surgical trainees need to learn how to perform independently (this gives them that chance). Prior studies find mixed results on outcomes, but most negative. Limitations include single center and limited surgeries.
5/x
Our group analyzed data from the Multicenter Perioperative Outcomes Group (MPOG): ~66,000 surgeries (total knee or hip arthroplasty; spine surgery; coronary artery bypass graft (CABG) surgery; and craniotomy) performed at 8 centers b/t 2010-2018
Our group analyzed data from the Multicenter Perioperative Outcomes Group (MPOG): ~66,000 surgeries (total knee or hip arthroplasty; spine surgery; coronary artery bypass graft (CABG) surgery; and craniotomy) performed at 8 centers b/t 2010-2018
6/x
In addition to its size and analysis of multiple surgery types, the empirical identification stemmed from analysis of overlapping vs non-overlapping surgeries of the same type (e.g., CABG) performed by the same surgeon. This addresses many but not all sources of confounding
In addition to its size and analysis of multiple surgery types, the empirical identification stemmed from analysis of overlapping vs non-overlapping surgeries of the same type (e.g., CABG) performed by the same surgeon. This addresses many but not all sources of confounding
7/x
3 basic findings:
1. Overlapping surgery appears generally safe in terms of inpatient mortality and complications, though surgical duration is longer (which is costly but on net may not be b/c of efficiencies gained by the practice)
3 basic findings:
1. Overlapping surgery appears generally safe in terms of inpatient mortality and complications, though surgical duration is longer (which is costly but on net may not be b/c of efficiencies gained by the practice)
8/x
2. Although overall complications were no higher, major complications (like PE, sepsis, AMI) were slightly higher in overlapping surgeries. This could be b/c inclusion of minor complications dilutes the effect, but its speculative.
2. Although overall complications were no higher, major complications (like PE, sepsis, AMI) were slightly higher in overlapping surgeries. This could be b/c inclusion of minor complications dilutes the effect, but its speculative.
9/x
3. For two groups, high-risk patients and CABG patients, mortality and complications were higher for overlapping surgery. We intuited that high risk patients (those w/ high predicted risk of peri-op complications) would be most vulnerable to any problems related to overlap.
3. For two groups, high-risk patients and CABG patients, mortality and complications were higher for overlapping surgery. We intuited that high risk patients (those w/ high predicted risk of peri-op complications) would be most vulnerable to any problems related to overlap.
10/x
The take-home points are that overlapping surgery generally appears safe, there are potential patients for whom additional concern may be warranted, and arguably the best empirical approach to studying this question is to look within-surgeon and within-procedure.
The take-home points are that overlapping surgery generally appears safe, there are potential patients for whom additional concern may be warranted, and arguably the best empirical approach to studying this question is to look within-surgeon and within-procedure.
11/11
With excellent team including @MichelleM_Mello and @sachinkheterpal who are on twitter and again led by Eric Sun, economist and anesthesiologist (in that order), from @StanfordMed
With excellent team including @MichelleM_Mello and @sachinkheterpal who are on twitter and again led by Eric Sun, economist and anesthesiologist (in that order), from @StanfordMed
