SAN DIEGO — It may be possible to perform concurrent neurological surgery cases with few complications when they are carried out within an appropriate framework that includes guidelines, according to a presenter at the Congress of Neurological Surgeons Annual Meeting, here.
“Obviously, concurrent surgery is very controversial and something that must be told [to] and discussed with the patients prior to performing it,” Jian Guan, MD, said. “However, I think with, again, these fairly stringent guidelines, it is something that can be done — it can be done safely and, as previously stated, it has multiple benefits for both patient and trainee.”
Guan and colleagues performed a retrospective chart review of 1,018 neurosurgical patients operated on between May 12, 2014 and May 12, 2015 by one of five neurosurgeons at University of Utah Hospital, in Salt Lake City, authorized to operate in concurrent ORs. The study’s primary outcome was the overall complication rate based on the Clavien-Dindo scale for 475 concurrent and 543 nonconcurrent surgical cases. Secondary outcomes included serious or life-threatening complications or life-ending complications.
“We looked at intraoperative, postoperative and post-discharge 30-day complications as one cluster,” Guan said.
Investigators defined concurrent surgery as any overlap that ranged from 1 minute to the entire duration of case when it occurred with another case.
Guan and colleagues analyzed such variables as demographics, BMI, insurance type, operative variables and comorbidities inclusive of American Society of Anesthesiologists (ASA) grade. With a univariate analysis, investigators compared total complications vs. no complications, as well as serious complications vs. no serious complications.
Results showed an average overlap time between the cases of 197.5 minutes and 271 total complications and 134 serious complications. The regression analysis for overall complications showed surgery category, surgery length, BMI, ASA grade and estimated blood loss were significantly associated with overall complications.
However, Guan said, “In our cohort, concurrent surgery was not associated with a higher rate of overall or serious or life-threatening complications.” – by Monica Jaramillo
Guan J., et al. Paper #408. Presented at: Congress of Neurological Surgeons Annual Meeting; Sept. 24-28, 2016; San Diego.
Disclosure: Guan reports no relevant financial disclosures.