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Overlapping Surgery in Plastic Surgery: An Analysis of Patient Safety and Clinical Outcomes

Parikh, Rajiv P. M.D., M.P.H.S.; Sharma, Ketan M.D., M.P.H.; Thornton, Melissa B.S.; Brown, Gabriella B.S.; Myckatyn, Terence M. M.D.

Plastic and Reconstructive Surgery: June 2019 - Volume 143 - Issue 6 - p 1787-1796
doi: 10.1097/PRS.0000000000005654
Plastic Surgery Focus: Special Topics
Patient Safety CME

Background: Overlapping surgery is an important and controversial health care issue. To date, there is minimal evidence on the safety of overlapping surgery in plastic surgery. The purpose of this study was to evaluate and compare outcomes for patients undergoing overlapping surgery versus nonoverlapping surgery in plastic surgery.

Methods: This is a retrospective cohort study of consecutive patients undergoing plastic surgery procedures at a tertiary academic center between January of 2016 and January of 2018. Demographic and procedural characteristics, clinical outcomes, and adverse events were analyzed for patients undergoing overlapping versus nonoverlapping surgery. An a priori power analysis was performed, and chi-square, Wilcoxon rank sum, and bivariate logistic regression tests were used for analyses.

Results: Eight hundred sixty-six patients constituted the study population: 555 (64.1 percent) underwent nonoverlapping surgery and 311 (35.9 percent) underwent overlapping surgery. There was no significant difference (p > 0.050) in mean age, body mass index, tobacco use, American Society of Anesthesiologists rating, or Charlson Comorbidity Index score between cohorts. Comparison of nonoverlapping and overlapping cases revealed no differences in complications (12.1 percent versus 11.9 percent; p = 0.939), reoperations (6.1 percent versus 6.8 percent; p = 0.717), readmissions (3.6 percent versus 3.5 percent; p = 0.960), or emergency room visits (4.7 percent versus 4.8 percent; p = 0.927). Stratification by procedure demonstrated no difference (p > 0.050) in complications between cohorts. Median operative time was significantly longer for overlapping operations (105 minutes versus 83 minutes; p = 0.004).

Conclusions: This study supports the safety of overlapping surgery in plastic surgery.


Patient Safety CME.

St. Louis, Mo.

From the Divisions of Plastic and Reconstructive Surgery and Public Health Sciences, Department of Surgery, Washington University School of Medicine.

Received for publication May 1, 2018; accepted November 16, 2018.

Disclosure:No direct funding was provided for this study. The authors declare no financial interests that pose a conflict of interest related to this article. Dr. Myckatyn receives investigator-initiated grant funding, consultant, and advisory board fees from Allergan, consultant fees from LifeCell, investigator-initiated grant funding and consultant fees from RTI, and advisory board fees from Viveve. None of these relationships relate to, or impacted, this study.

By reading this article, you are entitled to claim one (1) hour of Category 2 Patient Safety Credit. ASPS members can claim this credit by logging in to Dashboard, clicking “Submit CME,” and completing the form.

Terence M. Myckatyn, M.D., Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, 1020 North Mason Road, Suite 110, Building 3, St. Louis, Mo. 63141,, Twitter: @DrMyckatyn, Instagram: @terrymyckatyn

Copyright © 2019 by the American Society of Plastic Surgeons