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

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.