Multicenter Study Supports the Safety of Overlapping Orthopaedic Surgeries

    A study published in The Journal of Bone & Joint Surgery reports that for patients undergoing orthopaedic surgery, the practice of overlapping procedures does not lead to an increased risk of complications.

    According to this analysis of thousands of cases from 5 US medical centers, complication rates were at least as low in overlapping as in non-overlapping orthopaedic surgeries, which the researchers said suggests “that overlapping inpatient orthopaedic surgery does not introduce additional perioperative risk” for the complications they evaluated.

    Although the practice of overlapping surgeries is not new, it has become controversial in the wake of recent high-profile media reports.

    Most previous studies of overlapping surgery have found no increase in complications. However, these studies have had significant limitations – particularly in terms of small numbers of patients and low rates of overlapping surgeries.

    This study included 14,135 orthopaedic surgery procedures performed at 5 university medical centers during 2015, 40% of which were overlapping surgeries. The researchers defined overlapping surgeries as 2 incisions open simultaneously for 1 surgeon. They compared complication rates for patients undergoing overlapping versus non-overlapping procedures.

    The main analysis showed that overlapping surgery was non-inferior to non-overlapping surgery in terms of 30-day complication rate. In addition to being non-inferior, overlapping surgery was associated with a lower complication rate than non-overlapping surgery (1% vs 2%). The analysis was adjusted for other factors affecting the risk of complications, including patient medical conditions, the type of procedure, and the institution where the surgery was performed. Overlapping surgery was also associated with significant reductions in length of hospital stay and risk of hospital readmission.

    The researchers emphasized that their findings don’t mean that overlapping procedures reduce surgical risks. Rather, they write, “these findings likely reflect characteristics influencing surgical outcomes that we cannot reliably measure…such as individual procedure complexity and surgeon experience.”

    A survey published last year in The Journal of Bone and Joint Surgery reported that patients and families “aren’t comfortable” with the idea of overlapping surgeries. While the new findings support the safety of overlapping orthopaedic procedures, both studies emphasize the importance of patient understanding and informed consent.


    Dy CJ, Osei DA, Maak TG, et al. Safety of overlapping inpatient orthopaedic surgery: a multicenter study. J Bone Joint Surg. 2018 Nov 21;100(22):1902-1911. doi: 10.2106/JBJS.17.01625.