109 Impact of a More Restrictive Overlapping Surgery Policy An Analysis of Complication Rates, Resident Involvement, and Surgical Wait Times at a High-Volume Neurosurgical Department
Abstract INTRODUCTION Recently, overlapping surgery has been a source of controversy both in the popular press and within the academic medical community. There have been no studies examining the possible effects of more stringent overlapping surgery restrictions. The authors examined the impact of a new overlapping surgery policy on complication rates, neurosurgical resident education, and wait times for neurosurgical procedures. METHODS The authors performed a retrospective chart review of nonemergent neurosurgical procedures performed over two periods from June 1, 2014, to October 31, 2014 (pre-policy change) and from June 1, 2016, to October 31, 2016 (post-policy change) by any of 4 senior neurosurgeons at a single institution who were authorized to schedule overlapping cases. Information on preoperative evaluation, patient demographics, premorbid conditions, surgical variables, and postoperative course were collected and analyzed. RESULTS >Six hundred fifty-three patients met inclusion criteria for complications analysis. Of these, 378 (57.9%) underwent surgery before the policy change. On multivariable regression analysis, neither overlapping surgery (OR 1.072, 95% CI 0.710-1.620) nor the overlapping surgery policy change (1.057, OR 0.700 1.596) was associated with overall complication rates. Similarly, neither overlapping surgery (OR 1.472, 95% CI 0.883 2.454) nor the overlapping surgery policy change (OR 1.251, 95% CI 0.748 2.091) was associated with numbers of serious complications. After the policy change, the percentage of procedures in which the senior assistant was a post-residency fellow increased significantly, from 11.9% to 34.2% (P< 0.001). In a multiple linear regression analysis of surgery wait time, patients undergoing surgery post-policy change had significantly longer delays from the decision to operate to the actual neurosurgical procedure (P< 0.001). CONCLUSION At our institution, further restriction of overlapping surgery was not associated with a reduction in overall or serious complications. Resident involvement in neurosurgical procedures decreased significantly after the policy change, and our study suggests that waiting times for neurosurgical procedures also significantly lengthened.