​Overlapping surgery is rare, say the authors of a recent study published in JAMA Internal Medicine, but patients whose hip surgeries were "double-booked" were almost twice as likely to have postoperative complications such as infection, early revision, or dislocation. The study involved analyzing data from 2009–2014 from 960 hip fracture procedures and 1,560 total hip arthroplasty procedures that were performed while the attending surgeon was supervising another procedure in a different operating room at the same time for at least 30 minutes. Each patient whose procedure overlapped with another was then matched with a patient who had undergone a nonoverlapping procedure, as well as by age, sex, surgeon, procedure, and hospital. After matching, the authors determined that overlapping hip fracture repairs had a 90% increased risk of complications (hazard ratio 1.85; an increase from 6.4% to 10.4%) within one year of surgery compared with nonoverlapping hip fracture repairs. Hip replacement procedures had similar results (hazard ratio 1.79), but the increase (1.4% to 2.3%) was not as pronounced. The authors also found that every additional 10 minutes of overlap duration increased the risk of complications by 7%. Although these overlapped procedures accounted for 2.5% of all hip fracture repairs and 3.0% of hip replacements, and more than 70% were performed at teaching hospitals, the study authors suggest that having less experienced surgeons or trainees perform part of the procedures may be a contributing factor. For example, closure of the operative wound is often considered "noncritical" and may be delegated to surgical trainees. However, "inadequate closure increases the risk for prolonged wound healing and infection, which in turn increases the likelihood of early revision," according to the authors. The authors suggest that overlapping surgery may be safer when the surgical team has adequate time to prepare for multiple-patient surgeries—a provision that should be part of the informed consent process.

HRC Recommends: Risk managers at facilities that permit concurrent surgeries should ensure that policies are in place that address the provisions for overlapping procedures. Policies should ensure that the perioperative record documents a surgeon's presence during the procedure and that the operating room team is aware of the importance of reporting unexpected outcomes of cases involving overlaps in surgeons' schedules. Additionally, risk managers should review the informed consent process for these procedures and encourage surgeons to provide full disclosure to patients about their scheduled responsibilities.