Safety of Running Two Rooms: A Systematic Review and Meta-Analysis of Overlapping Neurosurgical Procedures

OBJECTIVE: Overlapping surgery, a long-standing practice within academic neurosurgery centers nationwide, has recently come under scrutiny from the government and media as potentially harmful to patients. Therefore, the objective of this systematic review and meta-analysis is to determine the safety of overlapping neurosurgical procedures. METHODS: The authors performed a systematic review and meta-analysis in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A review of PubMed and Medline databases was undertaken with the search phrase overlapping surgery AND neurosurgery AND outcomes. Data regarding patient demographics, type of neurosurgical procedure, outcomes, and complications were extracted from each study. The principle summary measure was odds ratio (OR) of the association of overlapping versus non-overlapping surgery with outcomes. RESULTS: The literature search yielded a total of 36 studies, of which 5 studies met inclusion criteria and were included in this study. These studies included a total of 25,764 patients undergoing neurosurgical procedures. Overlapping surgery was associated with an increased likelihood of being discharged home (OR, 1.32; 95% confidence interval [CI], 1.20-1.44; P < 0.001) and a reduced 30-day unexpected return to the operating room (OR, 0.79; 95% CI, 0.72-0.87; P < 0.001). Overlapping surgery did not significantly affect OR of length of surgery, 30-day mortality, or 30-day readmission. CONCLUSIONS: Overlapping neurosurgical procedures were not associated with worse patient outcomes. In addition, prospective studies are needed to assess the safety overlapping procedures.