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Understanding and Perception of Overlapping Surgery in an Orthopaedic Trauma Population

A Survey Study

Evans, Cody L., MD; Kahler, David M., MD; Weiss, David B., MD; Yarboro, Seth R., MD

JAAOS - Journal of the American Academy of Orthopaedic Surgeons: May 15, 2019 - Volume 27 - Issue 10 - p e473–e481
doi: 10.5435/JAAOS-D-17-00756
Research Article

Introduction: Recently, overlapping surgery has received attention on the national scale. This study quantifies orthopaedic trauma patients' familiarity and concern with overlapping surgery as it relates to their care.

Methods: A 15-question survey was voluntarily completed by 200 orthopaedic trauma patients in the outpatient setting of a level I trauma center. Three domains were evaluated in the survey: demographic data, familiarity with overlapping surgery, and the degree of concern with overlapping surgery. Patients read a position statement explaining the practice of overlapping surgery, and their changes in level of concern were evaluated. Descriptive statistics were used to evaluate the data.

Results: A total of 200 patients completed the survey, of which 98 (49%) were male. The age range was broadly distributed. After surgery, 124 patients (62%) were seen for follow up. The remaining 76 patients (38%) did not undergo surgery. Regarding the practice of overlapping surgery, 116 respondents (58%) had no knowledge. There were 127 patients (63%) who reported their concern level as a 1 on an ordinal scale from 1 to 5, corresponding to the lowest possible level. Overall, 182 patients (91%) reported a level of concern of 3 (the median) or less with an average score of 1.7, indicating a low average level of concern. Six patients (3%) reported the maximum level of concern. On the whole, 160 patients (80%) reported either a decreased level of concern or no change after reading our department's position statement on overlapping surgery. Of the 124 patients, 81 (65%) postoperatively reported that they perceived no effect by overlapping surgery. The most common factors cited as areas of concern by patients were the absence of attending physician in the operating room (26%), risk of error by the resident (34%), and risk of a missed step in the surgical procedure (31%).

Conclusion: These data indicate that most respondents had no previous knowledge of overlapping surgery and had a generally low level of concern with its use as practiced at our institution. Disclosing the use of overlapping surgery and its purpose to patients is an important component of preoperative counseling.

Level of Evidence: Level V

From the Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA.

Correspondence to Dr. Yarboro:

Dr. Kahler or an immediate family member has stock or stock options held in Johnson & Johnson. Dr. Weiss or an immediate family member serves as a paid consultant to Globus Medical and Synthes and serves as a board member, owner, officer, or committee member of the American Academy of Orthpaedic Surgeons and the Orthpaedic Trauma Association. Neither of the following authors nor any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Evans and Dr. Yarboro.

© 2019 by American Academy of Orthopaedic Surgeons
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