• Jason B Liu, Julia R Berian, Kristen A Ban, Yaoming Liu, Mark E Cohen, Peter Angelos, Jeffrey B Matthews, David B Hoyt, Bruce L Hall, and Clifford Y Ko.
• *American College of Surgeons, Chicago, IL †Department of Surgery, University of Chicago Medicine, Chicago, IL ‡Department of Surgery, Loyola University Medical Center, Maywood, IL §Department of Surgery, Washington University, St. Louis, MO ¶Center for Health Policy and the Olin Business School at Washington University, St. Louis, MO ||Saint Louis Veterans Affairs Medical Center, St. Louis, MO **BJC Healthcare, St. Louis, MO ††Department of Surgery, University of California Los Angeles David Geffen School of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, CA.
• Ann. Surg. 2017 Sep 1; 266 (3): 411-420.

ObjectiveTo determine whether concurrently performed operations are associated with an increased risk for adverse events.BackgroundConcurrent operations occur when a surgeon is simultaneously responsible for critical portions of 2 or more operations. How this practice affects patient outcomes is unknown.MethodsUsing American College of Surgeons' National Surgical Quality Improvement Program data from 2014 to 2015, operations were considered concurrent if they overlapped by ≥60 minutes or in their entirety. 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.ResultsThere were 1430 (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 = 2059/12,010 [17.1%]). 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 versus the non-concurrent. After propensity score matching and risk-adjustment, there was no significant association of concurrence with DSM (odds ratio [OR] 1.08; 95% confidence interval [CI] 0.96-1.21), reoperation (OR 1.16; 95% CI 0.96-1.40), or readmission (OR 1.14; 95% CI 0.99-1.29).ConclusionsIn these analyses, concurrent operations were not detected to increase the risk for adverse outcomes. These results do not lessen the need for further studies, continuous self-regulation and proactive disclosure to patients.

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