Commentary: Risk of overlapping surgery in cardiac surgery? Much ado about nothing

Central MessageOverlapping surgery has been a mainstay of complex cardiac repair since the legendary era DeBakey, Cooley, and Crawford; suggestions that this practice increases risk may be much ado about nothing.See Article page 155. Overlapping nothing. See is relatively new term for physicians, patients, health policy agencies to describe longstanding fairly common in cardiothoracic surgery: running 2 operative rooms. In 2015, concept gained wide attention after an exposé was published by Boston Globe Spotlight Team regarding potential risks lack patient awareness practice1Abelson J, Saltzman Kowalczyk L, Allen S. Clash name care. Globe. October 25, 2015. Available at: https://apps.bostonglobe.com/spotlight/clash-in-the-name-of-care/story/. Accessed December 16, 2019.Google Scholar; soon thereafter, publications overlapping followed from orthopedic other surgeons, some focusing on its controversy ethics.2Levin P.E. Moon D. Payne D.E. concurrent professional ethical analysis.J Bone Joint Surg Am. 2017; 99: 2045-2050Crossref PubMed Scopus (15) Google Scholar, 3Mello M.M. Livingston E.H. The evolving story surgery.JAMA. 318: 233-234Crossref (26) 4Zhang A.L. Sing D.C. Dang D.Y. Ma C.B. Black Vail T.P. et al.Overlapping ambulatory orthopaedic setting.J 2016; 98: 1859-1867Crossref (46) 5Zygourakis C.C. Sizdahkhani Keefe M. Lee J. Chou Mummaneni P.V. al.Comparison outcomes cost versus nonoverlapping spine surgery.World Neurosurg. 100: 658-664.e8Crossref (30) Scholar described as primary responsible surgeon participating another operation critical portions first are completed; typically, done with understanding there no need return operation. Usually, defined who performs all parts procedure always available operating room if needed. Although formal definition “critical” components procedure, these generally considered those require surgeon's specific expertise. American College Surgeons indicated acceptable approach managing long patients informed practice. contrast, (participating or more surgical procedures which performed simultaneously) deemed inappropriate Surgeons. A recent meta-analysis 14 studies (including neurologic, thoracic, cardiac, hip, knee, operations) found association increased early mortality morbidity.6Gartland R.M. Alves K. Brasil N.C. Mossanen Mort E. Wright C.D. al.Does result worse outcomes? systematic review meta-analysis.Am J Surg. 2019; 218: 181-191Abstract Full Text PDF (1) Generally, framed within context elective repair. Potential benefits include better use resources, facilitating greater volumes surgery, reducing waiting time specialty repairs, reduction costs associated academic medical institutions. addition, provides crucial learning opportunities residents during their training. However, high-profile study analyzed effects 8 different procedures; adjusted analysis showed coronary artery bypass grafting but not 7 (all noncardiac).7Sun Mello Rishel C.A. Vaughn M.T. Kheterpal Saager L. al.Association perioperative outcomes.JAMA. 321: 762-772Crossref (32) This finding raised concern although harmless most specialties, perhaps negatively affected issue Journal, Glauser colleagues8Glauser G. Goodrich McClintock S.D. Szeto W.Y. Atluri P. Acker M.A. short-term outcomes.J Thorac Cardiovasc 2021; 162: 155-164.e2Abstract have focused safety (which they including open endovascular part aortic repair); assessed effect timing overlap. authors used robust matching (coarsened exact matching) mitigate individual profile resulting 984 matched pairs without results regard morbidity, well readmission reoperation. also overlap (beginning end procedure) had studied. fill gap impact thoroughly investigated surgery. Few patient-matched published—not only any type mastery depends active mentorship can expose trainees many cases short window supervised operations Association outcomesThe Journal Thoracic Cardiovascular SurgeryVol. 162Issue 1PreviewThis seeks assess Full-Text