دورية أكاديمية
Outcomes from 871,441 Consecutive Surgical Procedures without Overlap or with Maximally Permissible Non-Concurrent Overlap.
| العنوان: | Outcomes from 871,441 Consecutive Surgical Procedures without Overlap or with Maximally Permissible Non-Concurrent Overlap. |
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| المؤلفون: | Borja AJ; Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA., Karsalia R; Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA., Gallagher RS; Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA., Strouz K; McKenna EpiLog Fellowship in Population Health, the University of Pennsylvania, Philadelphia, PA, USA., Na J; McKenna EpiLog Fellowship in Population Health, the University of Pennsylvania, Philadelphia, PA, USA., McClintock SD; The West Chester Statistical Institute and Department of Mathematics, West Chester University, 25 University Ave, West Chester, PA, USA., DeMatteo RP; Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA., Malhotra NR; Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.; McKenna EpiLog Fellowship in Population Health, the University of Pennsylvania, Philadelphia, PA, USA. |
| المصدر: | Annals of surgery [Ann Surg] 2024 May 10. Date of Electronic Publication: 2024 May 10. |
| Publication Model: | Ahead of Print |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: Lippincott Williams & Wilkins Country of Publication: United States NLM ID: 0372354 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1528-1140 (Electronic) Linking ISSN: 00034932 NLM ISO Abbreviation: Ann Surg Subsets: MEDLINE |
| أسماء مطبوعة: | Original Publication: Philadelphia, PA : Lippincott Williams & Wilkins |
| مستخلص: | Objective: To isolate the impact of subsumed surgery (a shorter procedure completed entirely during overlapping non-critical portions of a longer antecedent procedure) on patient outcomes. Summary Background Data: The American College of Surgeons recently recommended the elimination of "concurrent surgery" with overlap during a procedure's critical portions. Guidelines for non-concurrent overlap have been established, but the safety of subsumed surgery remains to be examined. Methods: All consecutive procedures from 2013 to 2021 within a multihospital academic medical center were included (n=871,441). Simple logistic regression was performed to compare postoperative events between patients undergoing non-overlap surgery (n=533,032) and completely subsumed surgery (n=11,319). Thereafter, coarsened exact matching was used to match patients with non-overlap and subsumed surgery 1:1 on CPT code, 18 demographic features, baseline health characteristics, and procedural variables (n=7,146). Exact-matched cases were subsequently limited to pairs performed by the same surgeon (n=5,028). Primary outcomes included 30-day readmission, ED visits, and reoperations. Results: Univariate analysis suggested that subsumed surgery had a higher 30-day risk of readmission (OR 1.55, P<0.0001), ED evaluation (OR 1.19, P<0.0001), and reoperation (OR 1.98, P<0.0001). When comparison was limited to the exact same procedure and patients were matched on demographics and health characteristics, there were no outcome differences between patients with subsumed surgery and non-overlapping surgery, even when limiting analyses to the same surgeon. Conclusions: Similar surgeries for similar patients result in similar outcomes whether there is completely subsumed or no overlap. Individual surgeons performing a specific procedure have no outcome differences with subsumed and non-overlapping cases. Competing Interests: Conflicts of Interest and Source of Funding: NRM received support from the Bernadette and Kevin McKenna Family Research Fund. The authors have no personal or institutional interest with regards to the authorship and/or publication of this manuscript. (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.) |
| تواريخ الأحداث: | Date Created: 20240510 Latest Revision: 20240510 |
| رمز التحديث: | 20240510 |
| DOI: | 10.1097/SLA.0000000000006340 |
| PMID: | 38726674 |
| قاعدة البيانات: | MEDLINE |
Full Text Finder | تدمد: | 1528-1140 |
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| DOI: | 10.1097/SLA.0000000000006340 |