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Outcomes of Concurrent Operations: Results from the American College of Surgeonsí National Surgical Quality Improvement Program
Jason B Liu*1, Julia R Berian*1, Kristen A Ban*1, Yaoming Liu*1, Mark E Cohen*1, Peter Angelos2, Jeffrey B Matthews2, David B Hoyt1, Bruce L Hall1, Clifford Y Ko1
1American College of Surgeons, Chicago, IL;2University of Chicago Hospitals, Chicago, IL

OBJECTIVE(S): Concurrent operations occur when a surgeon is responsible for two or more operations occurring simultaneously. Whether this practice affects patient outcomes is unknown.
METHODS: Using ACS NSQIP data from 2014-2015, operations were considered concurrent if they overlapped by ≥60 minutes or in their entirety (Figure). Propensity-score-matched cohorts were constructed to compare death or serious morbidity (DSM), unplanned reoperation, and unplanned readmission in concurrent versus non-concurrent operations. Multilevel hierarchical regression was used to account for the clustered nature of the data while controlling for procedure and case mix. Hospital characteristics were also considered.
RESULTS: There were 1,430 (32.3%) surgeons from 390 (77.7%) hospitals who performed 12,010 (2.3%) concurrent operations. Plastic Surgery (n=393 [13.7%]), Otolaryngology (n=470 [11.2%]), and Neurosurgery (n=2067 [8.4%]) were specialties with the highest proportion of concurrent operations. Spine procedures were the most frequent concurrent procedures overall (n=2,059/12,010 [17.1%]). Before propensity score matching, unadjusted rates of DSM (9.0% vs. 7.1%, p<0.001), reoperation (3.6% vs. 2.7%, p<0.001), and readmission (6.9% vs. 5.1%, p<0.001) were greater in the concurrent operation cohort. After matching and risk-adjustment, there was no significant association of concurrence with DSM (adjusted odds ratio [aOR] 1.08; 95% CI 0.96-1.21), reoperation (aOR 1.16; 95% CI 0.96-1.40), or readmission (aOR 1.14; 95% CI 0.99-1.29).
CONCLUSIONS: Concurrent operations at ACS NSQIP hospitals were not associated with increased risk for poor outcomes when compared to non-concurrent operations. These results do not preclude continuous self-regulation and proactive disclosure of its practice.
FIGURE. Representative concurrent operations included in the study.

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