American Surgical Association

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Association of Overlapping, Non-Concurrent, Surgery with Patient Outcomes at a Large Academic Medical Center: A Coarsened Exact Matching Study
Gregory Glauser*1, Benjamin Osiemo*2, Stephen Goodrich*2, Scott D. McClintock*2, Charles Vollmer1, Ronald DeMatteo1, Neil R. Malhotra*1
1University of Pennsylvania, Philadelphia, PA;2West Chester University, West Chester, PA

OBJECTIVE(S):
Contribute to the limited existing data on the safety of overlapping surgery. METHODS:
Coarsened exact matching was used to assess the impact of overlap on outcomes amongst all surgical interventions (n=61,524) over one-year (2014) at one health system. Overlap was categorized as any-overlap, beginning-overlap or end-overlap. Study subjects were matched on Charlson comorbidity score, duration of surgery, surgical costs, BMI, LOS, payer, and race amongst others. Serious unanticipated events were studied including unplanned return to OR, readmission, or mortality. RESULTS:
8391 patients had any-overlap and were matched (n=16,782, a 91.4% match rate). For beginning/end overlap matched groups were created (n=4534/3616 patients respectively, match rate was 96.3/94.5% respectively). Amongst matched patients, any-overlap did not predict unanticipated return to surgery (9.8% any-overlap vs 10.1% no overlap; p= 0.4481). Further, any-overlap predicted neither re-operation, re-admission, or ER visits at 30 or 90 days (30D readmission 9.9% vs 10.2%; p=0.4535, 90D readmissions 6.9% vs 7.0%; p=0.9004), (30D re-operation 3.6% vs 3.7%; p=0.8303, 90D re-operation 3.8% vs 3.9%; p=0.8377), (30D ER 5.4% vs 5.6%; p= 0.6039, 90D ER 4.8% vs 4.7%; p=0.7073). Beginning/end-overlap had a similar lack of association with serious unanticipated events (figure). However, end-overlap was associated with a reduced 30-day ER visit rate (4.4% vs 6.0%; p=0.0309). CONCLUSIONS:
Non-concurrent overlapping surgery is not associated with adverse outcomes in a large, matched population across one academic health system.

* By Invitation


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