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Purpose: To compare short-term complications and readmission rates, in patients treated with simultaneous versus staged bilateral total hip arthroplasty (THA) within a year from the index procedure. Methods: We reviewed the charts of patients that underwent simultaneous and staged—within a year—bilateral THA, between 2016 and 2020. Preoperative baseline characteristics were evaluated, while differences in terms of 30-day major and 30-day minor complications and readmission rates were compared between the groups. Results: One-hundred-sixty patients (mean age, 64.3 years; SD, ± 11.7) were identified. Seventy-nine patients were treated with simultaneous (Group A) and eighty-one patients with staged (Group B) THA. There were no differences in baseline characteristic between the two groups (p > 0.050). Group A was more likely to receive general anesthesia (43% vs. 9.9%, p < 0.001) and had longer total operative time (182.8 vs. 128.0 min, p < 0.001). Group A had an overall shorter total length of hospital stay (5.8 vs. 8.6 days, p < 0.001). No differences in transfusion rates (p = 0.229) and no differences in major and minor complications (p > 0.05) were identified. Postoperative visits at the emergency department or readmissions were similar between the two groups (p > 0.050). Conclusion: This study shows that similar complication and readmission rates are expected after simultaneous and staged THA. Simultaneous bilateral THA is a safe and effective procedure, that should be considered for patients that present with radiologic and clinical bilateral hip disease. [ABSTRACT FROM AUTHOR]

Overlapping surgery (OS) is a common practice in neurosurgery that has recently come under scrutiny. This study includes a systematic review and meta-analysis on articles evaluating the effects of OS on patient outcomes. PubMed and Scopus were searched for studies that analyzed outcome differences between overlapping and non-overlapping neurosurgical procedures. Study characteristics were extracted, and random-effects meta-analyses were performed to analyze the primary outcome (mortality) and secondary outcomes (complications, 30-day readmissions, 30-day operating room returns, home discharge, blood loss, and length of stay). Mantel–Haenszel tests were completed for binary outcomes, whereas the inverse variance tests were conducted for continuous outcomes. Heterogeneity was measured using the I2 and X2 tests. The Egger’s test was conducted to evaluate publication bias. Eight of 61 non-duplicate studies were included. Overall, 21,249 patients underwent non-OS (10,504 female) and 15,863 patients underwent OS (8393 female). OS was associated with decreased mortality (p = 0.002), 30-day returns to OR (p < 0.001), and blood loss (p < 0.001) along with increased home discharges (p < 0.001). High heterogeneity was observed for home discharge (p = 0.002) and length of stay (p < 0.001). No publication bias was observed. OS was not associated with worse patient outcomes compared to non-OS. However, considering multiple sources of limitation in the methodology of the included studies (such as limited number of studies, reports originating from mostly high-volume academic centers, discrepancy in the definition of “critical portion(s)” of the surgery across studies, and selection bias), extra caution is advised in interpretation of our results and further focused studies are warranted. [ABSTRACT FROM AUTHOR]

Background: Patients with coronary artery heart disease frequently suffer concomitant carotid vascular disease and are at high perioperative risk for neurological adverse events. Several concepts regarding the timing and modality of carotid revascularization are controversially discussed in patients with heart disease. Current guidelines recommendations on myocardial revascularization recommend a concomitant carotid endarterectomy (CEA) in patients with a history of stroke/transient ischemic attack (TIA) or 50–99% grade of the carotid stenosis. Our study aimed to analyze early outcome parameters of patients undergoing coronary artery bypass grafting (CABG), but also including concomitant heart valve surgery and simultaneous CEA. Methods: This study retrospectively analyzed a cohort of 111 patients from our institutional database undergoing heart surgery with CABG or heart-valve surgery between 2010 and 2020 with concomitant carotid surgery due to significant carotid stenosis. Results: Patients undergoing heart and simultaneous carotid surgery were 77 ± 8.0 years of age with a body mass index of 28 ± 1.7 kg/m2 and a mean EuroSCORE II of 6.5 ± 2.3. Most patients (61%) had a smoking history and arterial hypertension (97%). The preoperative mean grade of internal carotid stenosis was 87 ± 4.2%, 13% of patients suffered from internal carotid artery stenosis on both sites. In total, 4.5% of patients had previously undergone internal carotid artery intervention before and 6.3% had a history of stroke with a persistent neurologic disorder in 1.8%, 8.9% of cases had prior TIA. Thirty-day all-cause mortality was 6.3% and postoperative neurologic events occurred with 7.2% TIA and 4.5% of disabling stroke. Conclusion: Within the reported patient population of coronary artery heart disease and significant internal carotid stenosis, a one-time approach with CABG or heart-valve surgery and CEA is safe and feasible as justified by clinical and neurological postoperative outcomes. [ABSTRACT FROM AUTHOR]

Overlapping surgery (OS) occurs when a single surgeon is concurrently caring for patients in multiple operating rooms (OR) but is present for all critical portions of each surgery. Although this is common practice, most studies have found public disapproval of OS. This study aims to better understand attitudes toward OS of patients who gave informed consent for OS. Participant interviews covered topics including trust, OR personnel roles, and attitudes toward OS. Four representative transcripts were distributed among researchers for independent code identification. These were aggregated into a codebook, applied by two coders. Iterative and emergent thematic analyses were done. Twelve participants were interviewed to reach thematic saturation. Three themes shaped how participants felt about OS: trust in their surgeon, worries about OS, and understanding of OR personnel roles. Factors contributing to trust included personal research and the surgeon's experience. Frequently cited concerns were unpredictability of complications during operations and the surgeon's divided attention. Two participants inaccurately understood personnel roles, believing the surgeon did most or all the hands-on work while trainees were observers. Most participants felt a high or neutral level of comfort toward OS and indicated trust as the reason. In contrast to prior research, this study found that most participants had a neutral or positive view of OS. This suggests that a trusting relationship with their surgeon and informed consent are important factors in increasing comfort for OS. Participants who misunderstood OR roles felt less comfortable toward OS. This highlights an opportunity for patient education on trainee roles. [ABSTRACT FROM AUTHOR]

Objectives: The primary objective of this study was to analyze the relationship of percentage of surgical overlap with patient outcomes to determine if a detrimental level of overlap exists. Background: Overlapping surgery is defined as 1 attending physician supervising 2 or more operative cases simultaneously, without the critical portions of the cases occurring concurrently. To date, no study has examined the relationship of percent overlap, or the percentage of 1 case that is spent overlapping with another, to outcomes, efficiency, safety, and complications. Methods: This study is a retrospective cohort study conducted at a large tertiary referral center. The primary outcomes of interest included operative duration, in-hospital mortality, 30-day readmission, and patient safety indicators (PSIs). The Cochran-Armitage test for trend was used to evaluate the outcomes of interest. P values of ≤0.05 were considered statistically significant. Results: A total of 87,426 cases were included in this study. There were 62,332 cases without overlap (Group 0), 10,514 cases with 1% to 25% overlap (Group 1), 5303 cases with 26% to 50% overlap (Group 2), 4296 cases with 51% to 75% overlap (Group 3), and 4981 cases with >75% overlap (Group 4). In-hospital mortality decreased as overlap increased (P trend<0.0001). Operative time increased with increasing overlap (P trend<0.0001) while readmission rates showed no statistical significance between groups (P trend=0.5078). Rates of PSIs were lower for Groups 1, 2, and 3 (1.69%, 2.01%, and 2.08%) when compared to Group 0 (2.24%). Group 4 had the highest rate of PSIs at 2.35% (P =0.0086). Conclusion: Overlapping surgery was shown to have reduced in-hospital mortality and similar PSI and readmission rates when compared to nonoverlapping cases. Operative time was shown to increase in overlapping surgeries when compared to nonoverlapping surgeries. The results from this study indicate that the percentage of surgical overlap does not detrimentally affect most patient outcomes, especially with overlap of <75%. [ABSTRACT FROM AUTHOR]

Simple Summary: Patients who present with a primary colon or rectal cancer and are diagnosed with liver metastases at the same time (synchronous liver metastasis) have a number of treatment options when considering management. Providing systemic disease control alone involves several treatment considerations. For surgery, the decision rests with treating the primary tumor first, the liver metastasis first, or resection of both disease locations in one procedure. The decision rests on several conditions. Designing a trial to take all these factors into account while maintaining a reasonable endpoint for patients and caregivers is not straightforward. Here, we discuss some of the underlying points when considering simultaneous resection of colon or rectal cancer with liver metastases. In patients presenting with colorectal cancer and synchronous liver metastases, the disease burden related to the liver metastasis is the driving cause of limited longevity and, eventually, risk of death. Surgical resection is the potentially curative treatment for colorectal cancer liver metastases. In the synchronous setting where both the liver metastases and the primary tumor are resectable with a relative low risk, the oncological surgeon and the patient may consider three potential treatment strategies. Firstly, a "staged" or a "simultaneous" surgical approach. Secondly, for a staged strategy, a 'conventional approach' will suggest removal of the primary tumor first (either colon or rectal cancer) and plan for liver surgery after recovery from the first operation. A "Liver first" strategy is prioritizing the liver resection before resection of the primary tumor. Planning a surgical trial investigating a two-organ oncological resection with highly variable extent and complexity of resection as well as the potential impact of perioperative chemo(radio)therapy makes it difficult to find the optimal primary endpoint. Here, we suggest running investigational trials with carefully chosen composite endpoints as well as embedded risk-stratification strategies to identify subgroups of patients who may benefit from simultaneous surgery. [ABSTRACT FROM AUTHOR]

The American College of Surgeons (ACS) updated its guidelines on overlapping surgery in 2016. The objective was to examine differences in postoperative outcomes after overlapping surgery either pre-ACS guideline revision or post-guideline revision, in a coarsened exact matching sample. A total of 3327 consecutive adult patients undergoing single-level posterior lumbar fusion from 2013 to 2019 were retrospectively analyzed. Patients were separated into a pre-ACS guideline revision cohort (surgery before April 2016) or a post-guideline revision cohort (surgery after October 2016) for comparison. The primary outcomes were proportion of cases performed with any degree of overlap, and adverse events including 30-day and 90-day rates of readmission, reoperation, emergency department visit, morbidity, and mortality. Subsequently, coarsened exact matching was used among overlapping surgery patients only to assess the impact of the ACS guideline revision on overlapping outcomes, and controlling for attending surgeon and key patient characteristics known to affect surgical outcomes. After the implementation of the ACS guidelines, fewer cases were performed with overlap (22.0% vs. 53.7%; P < 0.001). Patients in the post-ACS guideline revision cohort experienced improved rates of readmission and reoperation within 30 and 90 days. However, when limited to overlapping cases only, no differences were observed in overlap outcomes pre-ACS versus post-ACS guideline revision. Similarly, when exact matched on risk-associated patient characteristics and attending surgeon, overlapping surgery patients pre-ACS and post-ACS guideline revision experienced similar rates of 30-day and 90-day outcomes. After the ACS guideline revision, no discernable impact was observed on postoperative outcomes after lumbar fusion performed with overlap. [ABSTRACT FROM AUTHOR]

Purpose Overlapping surgery or double-booking is a vital yet disputed issue in healthcare field. However, safety of the overlapping surgery during laparoscopic common bile duct exploration (LCBDE) remains unclear. This study aimed to assess the clinical outcomes and safety of overlapping surgery during laparoscopic cholecystectomy and LCBDE for gallbladder and common bile duct stones (CBDS). Material and Methods This study retrospectively reviewed 2736 laparoscopic cholecystectomy and LCBDE surgeries during 2013–2020. One thousand, two hundred eighty patients underwent LCBDE through cystic duct, including 867 receiving overlapping procedures, while 1456 underwent LCBDE through laparoscopic choledochotomy (LC), including 981 who underwent overlapping procedures. Data regarding patient sex, age, body mass index, the American Society of Anesthesiology grade, comorbidities, preoperative liver function test, previous upper abdominal surgery, presence of acute cholecystitis, cholangitis, pancreatitis, or jaundice, common bile duct (CBD) or CBDS diameter, CBDS number, LCBDE operation time, procedure duration, length of stay, stone clearance, CBD closure methods, conversion to open surgery, and complications were collected. Results Differences in demographics and clinical variables between both groups were not significant, and the unadjusted outcomes were comparable, except for the total procedure duration (transcystic: p

Background: Accurate localization of pulmonary nodules is the main difficulty experienced in wedge resection. Commonly used localization methods have their own advantages and disadvantages. However, clinical work has demonstrated that intraoperative indocyanine green localization under electromagnetic navigation bronchoscopy/virtual navigation bronchoscopy (VNB) is more advantageous than conventional methods for patients with multiple pulmonary nodules undergoing simultaneous surgery, especially for those undergoing bilateral lung surgery. Methods: Data of patients undergoing simultaneous surgery for multiple pulmonary nodules with preoperative methylene blue localization by computed tomography (CT)‐guided percutaneous lung puncture (methylene blue group) or intraoperative indocyanine green localization under VNB (virtual navigation group) were retrospectively analyzed. Patient characteristics, pulmonary nodule features, localization time, preoperative location time, location success rate, operation time, complication incidence, visceral pleural staining rate after localization, and pulmonary nodule primary resection success rate were compared between the two groups. Results: The methylene blue and virtual navigation groups comprised 39 and 20 patients with 119 and 67 pulmonary nodules resected, respectively. Sex, age, number of pulmonary nodules resected simultaneously, unilateral/bilateral lung surgery, pulmonary nodule size, distance between pulmonary nodules and the visceral pleura, pulmonary nodule consolidation‐to‐tumor ratio, location of pulmonary nodules in the pulmonary lobe, postoperative pathology, visceral pleura staining rate, primary pulmonary nodule resection success rate, and surgical duration did not differ significantly between the groups (p > 0.05). The localization time of the virtual navigation group was significantly shorter than that of the methylene blue group (p < 0.05), regardless of unilateral or bilateral multiple nodules. In the methylene blue group, 25.64% (10/39) of patients presented complications, all of which were pneumothorax, whereas no complications were found in the virtual navigation group. Conclusions: For patients with multiple pulmonary nodules undergoing simultaneous surgery, indocyanine green injection under VNB can achieve a similar effect on pulmonary nodule localization as classical methylene blue injection under CT‐guided percutaneous lung puncture, with shorter localization time and fewer complications. [ABSTRACT FROM AUTHOR]

Background. Simultaneous or delayed surgery for synchronous colorectal liver metastases is performed in the clinic; which method is better is still up for debate. In particular, infectious complications are rarely compared. This study aims to investigate the differences between simultaneous and delayed surgery for synchronous colorectal liver metastases by comparing infectious complications and prognosis. Methods. Firstly, the patients' information from a single institution's database was retrospectively analyzed. Then the patients were divided into a simultaneous group and a delayed group according to synchronous colorectal liver metastases. Analyzing the postoperative complications within 30 days, the progression-free survival, and the overall survival in the two groups. Results. The simultaneous group had a higher neo-adjuvant chemotherapy rate (42.0% VS. 16.0% in the delayed group, P < 0.05) and laparoscopic surgery rate (89.8% VS. 72.0% in the delayed group, P < 0.05) than the delayed group. Moreover, the simultaneous group had a higher liver-related infection rate (17.0 VS. 0.0% in the delayed group, P < 0.05). Conclusion. Although there was no difference in survival rate between delayed and simultaneous surgeries, the delayed surgery have fewer liver-related infections compared with the simultaneous surgery in synchronous colorectal liver metastases patients. Delayed surgery could be a better treatment method for synchronous colorectal liver metastases patients. [ABSTRACT FROM AUTHOR]

Objective. To investigate the changes in cardiopulmonary function in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) by one-stage multiplane surgery. Methods. 70 patients with moderate and severe OSAHS underwent nasal in our hospital from July 2017 to February 2021, palatopharyngeal, and/or tongue operations simultaneously and were followed up for 6 months. The Epworth Sleeping Scale (ESS) scores of patients before and after surgery were compared to observe the surgical efficacy, and the changes in the cardiopulmonary function of patients before and after surgery were detected. The static and dynamic indexes of cardiopulmonary function, respiratory disturbance index (AHI), and blood oxygen saturation (SaO2) were compared before and after the operation. Results. After surgery, all patients' indexes of static lung function were improved compared with that before surgery. After surgery, the percentage of maximal oxygen uptake peak to the predicted value, percentage of oxygen pulse to the predicted value, the ratio of oxygen uptake power, anaerobic threshold, and maximum ventilatory capacity per minute/maximum exercise volume were increased compared with that before surgery, and AHI and SaO2 were improved compared with that before surgery. Conclusion. This study suggests that it is feasible for patients with OSAHS who are unable to tolerate or unwilling to undergo noninvasive assisted ventilation to undergo simultaneous surgery for multiplane stenosis. It can reduce clinical symptoms and improve cardiopulmonary function. [ABSTRACT FROM AUTHOR]

This article reviews the background to overlapping surgery, in which a single senior surgeon operates across two parallel operating theatres; anaesthesia is induced and surgery commenced by junior surgeons in the second operating theatre while the lead surgeon completes the operation in the first. We assess whether there is any theoretical basis to expect increased productivity in terms of number of operations completed. A review of observational studies found that while there is a perception of increased surgical output for one surgeon, there is no evidence of increased productivity compared with two surgeons working in parallel. There is potential for overlapping surgery to have some positive impact in situations where turnover times between cases are long, operations are short (<2 h) and where 'critical portions' of surgery constitute about half of the total operation time. However, any advantages must be balanced against safety, ethical and training concerns. [ABSTRACT FROM AUTHOR]

Objective: To model the financial impact of policies governing the scheduling of overlapping surgeries, and to identify optimal solutions that maximize operating efficiency that satisfy the fiduciary duty to patients. Background: Hospitals depend on procedural revenue to maintain financial health as the recent pandemic has revealed. Proposed policies governing the scheduling of overlapping surgeries may dramatically impact hospital revenue. To date, the potential financial impact has not been modeled. Methods: A linear forecasting model based on a logic matrix decision tree enabled an analysis of surgeon productivity annualized over a fiscal year. The model applies procedural and operational variables to policy constraints limiting surgical scheduling. Model outputs included case and financial metrics modeled over 1000-surgeon-year simulations. case metrics included annual case volume, case mix, operating room (OR) utilization, surgeon utilization, idle time, and staff overtime hours. Financial outputs included annual revenue, expenses, and contribution margin. Results: The model was validated against surgical data. case and financial metrics decreased as a function of increasingly restrictive scheduling scenarios, with the greatest contribution margin loses ($1,650,000 per surgeon-year) realized with the introduction of policies mandating that a second patient could not enter the OR until the critical portion of the first surgery was completed. We identify an optimal scheduling scenario that maximizes surgeon efficiency, minimizes OR idle time and revenue loses, and satisfies ethical obligations to patients. Conclusions: Hospitals may expect significant financial loses with the introduction of policies restricting OR scheduling. We identify an optimal solution that maximizes efficiency while satisfying ethical duty to patients. This forecast is immediately relevant to any hospital system that depends upon procedural revenue. [ABSTRACT FROM AUTHOR]

A rare complication of acute cholecystitis is a pseudoaneurysm of the cystic artery. We discuss a case of a 65-year-old man with synchronous cholecystoenteric fistula and cystic artery pseudoaneurysm managed by selective angioembolization of the cystic artery, followed by interval cholecystectomy. [ABSTRACT FROM AUTHOR]

Overlapping surgery or double-booking is a vital yet disputed issue in healthcare field. However, safety of the overlapping surgery during laparoscopic common bile duct exploration (LCBDE) remains unclear. This study aimed to assess the clinical outcomes and safety of overlapping surgery during laparoscopic cholecystectomy and LCBDE for gallbladder and common bile duct stones (CBDS). This study retrospectively reviewed 2736 laparoscopic cholecystectomy and LCBDE surgeries during 2013–2020. One thousand, two hundred eighty patients underwent LCBDE through cystic duct, including 867 receiving overlapping procedures, while 1456 underwent LCBDE through laparoscopic choledochotomy (LC), including 981 who underwent overlapping procedures. Data regarding patient sex, age, body mass index, the American Society of Anesthesiology grade, comorbidities, preoperative liver function test, previous upper abdominal surgery, presence of acute cholecystitis, cholangitis, pancreatitis, or jaundice, common bile duct (CBD) or CBDS diameter, CBDS number, LCBDE operation time, procedure duration, length of stay, stone clearance, CBD closure methods, conversion to open surgery, and complications were collected. Differences in demographics and clinical variables between both groups were not significant, and the unadjusted outcomes were comparable, except for the total procedure duration (transcystic: p <.001; LC: p <.001). After adjusting for demographics and clinical variables, overlapping surgery showed an extended total surgical procedure duration (transcystic: standardized coefficient = 0.084, p =.004; LC: standardized coefficient = 0.072, p =.015). Other effects of overlapping surgery were also comparable. Overlapping surgery in laparoscopic cholecystectomy and LCBDE was safe at our institution. However, the association of patient outcomes with overlapping laparoscopic cholecystectomy and LCBDE should be further investigated. [ABSTRACT FROM AUTHOR]

Supplemental Digital Content is available in the text Objective: The aim of the study was to characterize surgeon perspectives regarding the benefits and downsides of conducting overlapping surgery. Background: Although surgeons are key stakeholders in current discussions surrounding overlapping surgery, little has been published regarding their opinions on the practice. Further characterization of surgeon perspectives is needed to guide future studies and policy development regarding overlapping surgery. Methods: Study information was sent to all members of 3 professional surgical societies. Interested individuals were eligible to participate if they identified as attending surgeons in an academic setting who work with trainees. Purposive selection was used to diversify surgeons interviewed across multiple dimensions, including subspecialty and opinion regarding appropriateness of overlapping surgery. In-depth, qualitative interviews were conducted with participants regarding their opinions on overlapping surgery. Results: The 51 surgeons interviewed identified a wide array of potential benefits and disadvantages of overlapping surgery, some of which have not previously been measured, including downsides to surgeon wellness and patient experience, less surgeon control over procedures, and difficulty in scheduling cases. Interviewees often disagreed as to whether overlapping surgery negatively or positively affects each dimension discussed, particularly regarding the impact on resident training. Conclusions: The utilization of the novel perspectives presented here will allow for targeted assessment of physician perspectives in future quantitative studies and increase the likelihood that variables measured encompass the range of factors that surgeons find meaningful and relevant. Priority areas of future research should include examining effects of overlapping surgery on surgical training and surgeon wellness. [ABSTRACT FROM AUTHOR]

Background: Surgical procedures scheduled staggered between two operating rooms increase efficiency by eliminating turnover time. However, the practice might increase the surgeon's fatigue. Overlapping surgery has been assumed to be safe because no critical portions of procedures are performed simultaneously in two rooms, but there is little evidence in the literature to support that assumption for otolaryngologic surgery, and there is no evidence comparing non-overlapping and overlapping surgical outcomes for a single surgeon with all confounding factors controlled., Methods: Retrospective cohort study that included a consecutive sample of adult subjects who underwent otolaryngologic laryngeal or otologic surgery between June 2013 and March 2016. All procedures were performed by the same surgical team and surgeon who had block time with 2-rooms every other week and 1-room on alternate weeks. The incidence of surgical complications was assessed in the perioperative period. Duration of surgery and time-in-room also were evaluated, as were surgical outcomes., Results: A total of 496 surgeries were assigned to either overlapping-surgery (n = 346) or non-overlapping-surgery (n = 150) cohorts. Overlapping-surgery was a significant predictor for increased time-in-room on multivariate analysis but was not a significant predictor for surgery duration. Rate of complications, hospital readmission, emergency department visit, reoperation, mortality, and patient satisfaction did not differ significantly between cohorts., Conclusions: Overlapping surgery does not hinder patient safety or functional outcomes in patients undergoing otolaryngologic operations such as voice or ear surgery., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Hypertrophy of the labia minora with clitoral hood redundancy always occurs simultaneously and should be considered in its entirety. This study investigated a new simultaneous procedure for the clitoral hood-labia minora complex (CLC) that retains the central neurovascular pedicle., Methods: This retrospective observational study, conducted between January 2021 and August 2022, included 29 patients with labia minora hypertrophy and clitoral hood redundancy who underwent a surgery wherein procedures on the CLC were performed simultaneously. A divisional design to separate the medial and lateral labia minora and to remove the skin and subcutaneous tissue asymmetrically, while retaining the central neurovascular pedicle and the natural margin of labia minora, was employed. Postoperatively, all patients were followed up via the Internet or at the outpatient clinic. The follow-up included observing postoperative outcomes and any complications and completing the satisfaction questionnaires., Results: All the patients who underwent surgery showed good wound healing without discomfort of thread friction. Postoperatively, the labia minora had a natural appearance and retained sexual sensitivity. The scarring on the surgical incision was not evident. Hematoma and evident bilateral asymmetry occurred in one patient each. The satisfaction rate within 14 days and after 3 months of surgery was 96.6% and 92.6%, respectively., Conclusions: This method uses a hidden incision, to remove the hypertrophic tissue and retain the natural edge and shape of the labia minora. Qualitatively, the patients were highly satisfied. This method was safe, effective, and easy to implement., Level of Evidence Iv: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 ., (© 2023. Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery.)

Introduction. Simultaneous Bilateral Cataract Surgery (SBCS) is still a relatively controversial procedure. The main objection is the risk of bilateral endophthalmitis or bilateral refractive error. However, SBCS has also some advantages (faster visual rehabilitation, lower risk of nosocomial infection, and lower cost). Performing surgery on both eyes in one session has one additional advantage which has not yet been described in the literature (according to the information available to authors). It allows surgeons to distinguish the effect of minor differences in the surgical protocol on the subjective perception of the procedure more accurately, which is a more suitable method than comparing two independent groups of patients. Purpose. To compare the effect of minor changes in the surgical protocol during SBCS on intraindividual subjective perception of surgery (pain, pressure, glare, and perception of the duration of the surgery). Methods. During the surgery of the right and left eyes of one patient, we randomly changed one surgical parameter (use of intracameral anesthesia, light intensity of the operating microscope, type of eyelid speculum, creation of the posterior circular capsulorhexis, and communication with the patient during surgery). Patients immediately after both surgeries subjectively evaluated the perception of pain (on the scale 0–10), pressure, and glare (on the scale 0–5) and estimated the duration of the surgery, separately for each eye. Each change was evaluated in a group of 50 patients. Results. In the control group with no parameters changed, we noted no difference in subjective perception of the first and second surgery. In subgroups, where we changed the protocol, we detected only minor differences in subjective perception of pain, pressure, glare, and duration of the surgery. Only one statistically significant difference in subjective pain perception was in the subgroup where we used eye intracameral anesthesia (0.34 eyes with intracameral anesthesia, 0.44 eyes with only topical anesthesia). We did not note any statistically significant differences in the perception of the time of surgery. Conclusion. SBCS can be used to optimize the parameters of cataract surgery. In our study, we noted a positive effect of intracameral anesthesia on subjective perception of surgery. [ABSTRACT FROM AUTHOR]

Background Context: Recent media coverage of overlapping surgery has led to several studies investigating public perception of concurrent and overlapping surgery, both of which involve a single attending surgeon working on two separate cases in two separate operating rooms. In concurrent surgery, the critical periods of the surgeries overlap, while in overlapping surgery they do not. The literature revealed a general lack of knowledge about these practices and strong disapproval of their use by the public.Purpose: To determine the comfort level of spine surgery patients and their family members toward concurrent and overlapping surgery.Study Design/setting: This cross-sectional survey study was performed at an urban, adult academic spine surgery clinic.Patient Sample: Patients and their companions who were waiting to be seen at their initial clinic visit or follow-up visit were approached to participate in the study.Outcome Measures: The survey queried respondents' baseline knowledge of and comfort level with concurrent and overlapping surgery, in addition to comfort level with different levels of surgical trainees on a 5-point Likert scale.Methods: A five-section, 36-item questionnaire was administered by a research assistant to respondents over a 3-month period spanning June 2019 - August 2019. A research assistant described the terms overlapping surgery and concurrent surgery to participants of the survey using diagrams and a preformulated script after self-reported knowledge questions. Statistical analysis was performed using the chi-square test for categorical variables, and Kendall's tau-c rank correlation coefficient with ordinal independent variables for correlations.Results: Knowledge about concurrent and overlapping surgery was low in our study population (8.22% and 6.16%, respectively). Over half of respondents reported that they felt comfortable with overlapping surgery (58.22%). Most respondents reported that they would like their surgeon to disclose the participation of surgical trainees (residents and fellows) in their surgery (98%). In addition, the 4th and 5th years of surgical training were associated with a significant increase in patient comfort with surgical trainee participation. There was no difference in response distribution between patients versus nonpatients.Conclusions: Knowledge about concurrent and overlapping surgery remains poor in our study population. Lack of general knowledge about overlapping surgery can be a serious impediment to obtaining informed consent, and further study is required to determine the best methods to raising patient awareness. [ABSTRACT FROM AUTHOR]

The authors surveyed hospitals across the country on their policies regarding overlapping surgery, and found large variation between hospitals in how this practice is regulated. Specifically, institutions chose to define "critical portions" in a variety of ways, ultimately affecting not only surgical efficiency but also the autonomy of surgical trainees and patient experiences at these different hospitals. [ABSTRACT FROM AUTHOR]

Background: This paper reports the first case of simultaneous bilateral cochlear implant surgery performed exclusively with a three-dimensional exoscope. It also discusses the optimum operative set-up and the feasibility of three-dimensional exoscopic ear surgery as an alternative to the microscope. Method: The Vitom three-dimensional exoscope system (Karl Storz) was used. Results: The surgery was successfully completed, with no peri-operative complications. Both the operation time and the surgical outcome for the patient were comparable with the previous cochlear implant surgical procedures performed in our centre using the conventional operating microscope. Conclusion: This paper demonstrates that exclusive use of the three-dimensional exoscope is a viable alternative to the operating microscope for selected otological cases. It is clear that the three-dimensional exoscopic technique is potentially very promising for future surgical procedures, provided that cases are selected carefully to prevent compromising exposure, efficiency or patient safety. [ABSTRACT FROM AUTHOR]

Objective: To compare follow-up outcomes of ureteroscopy (URS) and shockwave lithotripsy (SWL) for ureter calculi in the setting of asymptomatic renal calculi <15 mm.Methods: This study included 789 patients who underwent URS (n = 301) or SWL (n = 488) as primary treatment for ureter calculi and who had ipsilateral renal calculi <15 mm between January 2012 and December 2019. For the URS group, all renal calculi were simultaneously treated unless contraindicated. One-to-one matching was performed using the propensity score (PS).Results: After PS matching, analysis included 262 matched pairs of URS and SWL patients. The stone-free rate for ureter calculi without auxiliary procedure was 97.3% in the URS group and 93.9% in the SWL group. Any complication rates were 11.0% and 9.2% in the URS and SWL group, respectively; 1.1% of the URS patients experienced complications classified as Clavien-Dindo ≥IIIb. The estimated 2-year intervention-free survival was 88.1% in the URS group and 84.2% in the SWL group (P = 0.045). The estimated 2-year stone-event-free survival was 80.1% in the URS group and 71.0% in the SWL group (P = 0.009). Cox multivariate analysis showed that the hazard ratios of URS were 0.62 (P = 0.025) for surgical interventions and 0.64 (P = 0.008) for stone-related events after adjusting for baseline variables.Conclusion: For patients with symptomatic ureter calculi and asymptomatic renal calculi <15 mm, URS with active treatment for renal calculi reduces future ipsilateral surgical intervention and stone-related events compared with SWL for ureter calculi. [ABSTRACT FROM AUTHOR]

Objective: Policy concern and debate surround the concept of overlapping spine surgery. Overlapping surgery specifically refers to nonessential portions of the case or noncutting time overlap. This differs from concurrent surgery, in which critical portions of the procedure overlap. Here the authors explore the barriers for safe and efficient overlapping surgery in academic spinal deformity practice., Methods: Over a 24-month period, cases of spinal deformity, degenerative cases, anterior cervical discectomy and fusions (ACDFs), and laminectomy were reviewed for duration in operating room (OR) prior to surgery, duration of cutting time, duration in OR after surgery, turnover duration, and time delay from initial start time. Standard degenerative cases were referenced as 1-2 ACDFs as well as 1- to 2-level laminectomy surgery. The blocks of time between two consecutive cutting periods were investigated to determine the feasibility of overlapping an additional surgery. Specifically, the authors compared the blocks of time that include the postsurgery period, the turnover period, and the presurgery period to cutting periods., Results: One hundred twenty-six complex spinal deformity procedures and 85 degenerative cases (including 49 ACDFs and 36 laminectomies) from one center and one neurosurgeon were reviewed. These procedures were performed between September 2019 and December 2021 with a 3-month gap in military deployment. On average, the procedure's duration for cases of deformity was 236.5 minutes, for cases of ACDFs it was 84 minutes, and for cases of laminectomies it was 105.5 minutes. The block of noncutting time while the patient was in the OR showed no difference from the surgical cut time. The turnover time between cases was 52.35 minutes. Of 100 cases scheduled as the first case of the day, 94 had a delay to the OR averaging 18.2 minutes., Conclusions: The data in this study indicate that estimates for pre- and postsurgical times alone are not sufficient to allow for overlapping surgery. The average cut-time duration of ACDF was 84 minutes; the average presurgical time for deformity was 68 minutes. This highlights the critical analysis for further examination of optimal scheduling, on-time first start, turnover periods, and the orchestration of all members of the providing team to optimize the cutting time for safe and consistent implementation of overlapping spine surgery.

Objectives/Hypothesis: To explore patient values associated with their comfort level with surgical trainees and attending surgeon absence from the operating room. Study Design: Qualitative interviews with general medical patients. Methods: We analyzed data from qualitative interviews with patients that included a quantitative rating on a visual analog scale (VAS) of comfort consenting to three surgical scenarios, including overlapping surgery, to identify subgroups of patients based on comfort level. After identifying subgroups, we compared qualitative responses from participants who were generally comfortable with overlapping surgery to those who were uncomfortable to identify themes associated with these perceptions. Results: We identified three subgroups of patients based on the patterns of VAS responses. Participants who were comfortable with overlapping surgery expressed trust in the surgeon and delegation process. Those who were most uncomfortable expressed a strong desire to know who was operating on them, and a desire for control over their surgical process. Subjects uncomfortable with overlapping surgery were also generally not sensitive to tradeoffs (cost, timing). Conclusions: We identified distinct subgroups of patients based on their comfort level with trainee independence and primary attending availability. By examining the predominant values in these subgroups, we identified potential explanations for patient discomfort with attending absence. Strategies to enhance patients' knowledge about the process of surgery and a sense of control over their own care may improve comfort with trainee participation and overlapping surgery. Level of Evidence: 6 Laryngoscope, 2019 [ABSTRACT FROM AUTHOR]

Introduction: Surgical lengthening and angular correction of the limbs are an option for treating the orthopedic clinical manifestations in patients with achondroplasia. This study assesses a staged limb lengthening protocol, performing simultaneous bilateral lengthening of the femur and tibia (stage I [S1]), and humeral lengthening (stage II [S2]).Materials and Methods: Twenty-one achondroplastic patients were included in this study, and 106 segments (34 femurs, 34 tibias and 38 humeri) were lengthened. Achondroplasia patients with a growth curve below the mean of the standard growth curves for achondroplasia were included in S1. The remaining patients were included directly in S2. Variables analyzed included anthropometric measurements, lengthening outcomes, difficulties, and functionality.Results: Of the all patients included in the protocol, 15 patients completed S1 and S2, 4 only completed S2, and 2 only completed S1. Height and limb-trunk ratio before S1 were 107.65 ± 7.14 cm and 1.89 ± 0.10 and after S1 were 126.50 ± 9.19 cm and 1.64 ± 0.09, respectively. Limbs were lengthened 14.43 ± 1.41 cm (femurs and tibias) for S1 and 9.95 ± 0.60 cm for S2 (humeri), with a stage healing index of 18.23 ± 3.54 in S1 and 28.92 ± 4.42 in S2. Correction of lower angular deviations, functional improvement, and a controlled complications rate were achieved in all patients.Conclusions: The limb lengthening protocol proposed in this study is a suitable treatment for achondroplasia patients to achieve the agreed-upon objectives (limb-trunk ratio, improved functionality, and lower limb alignment). The reproducibility of the procedure and patient safety were upheld. [ABSTRACT FROM AUTHOR]

Objectives: To examine opinions on trainee independence and attending presence among a cross-section of the general population and explore how perceptions of trust, past experiences, and demographics interacted with comfort consenting to these surgical scenarios.Study Design: Mixed-methods METHODS: Based on prior qualitative analysis, we designed a survey of patient preferences and values that focused on trust in healthcare practitioners and processes, which also included comfort ratings of three surgical scenarios (including overlapping surgery). The survey was administered to a sample from the general public using Mechanical Turk. We identified discreet domains of trust and examined the association of responses to these domains with comfort ratings, prior healthcare experiences, and demographics.Results: We analyzed 225 surveys and identified four patient subgroups based on responses to the surgical scenarios. Subjects that were more comfortable with overlapping surgery were more trusting of trainees and delegation by the attending. Past experiences in healthcare (positive and negative) were associated with multiple domains of trust (in trainees, surgeons, and the healthcare system). Demographics were not predictive of trust responses or comfort ratings.Conclusion: Patients express varying degrees of comfort with overlapping surgery, and this is not associated with demographics. Past negative experiences have an impact on trust in the healthcare system overall, and trust in trainees specifically predicts comfort with attending absence from the operating room. Efforts to increase patient comfort with overlapping surgery and surgical training should include strategies to address past negative experiences and foster trust in trainees and the delegation process.Level Of Evidence: IV Laryngoscope, 130:2728-2735, 2020. [ABSTRACT FROM AUTHOR]

Objective: To compare outcomes in otolaryngology between overlapping and nonoverlapping surgeries.Study Design: Retrospective cohort study.Setting: Tertiary referral center.Subjects and Methods: All patients undergoing otolaryngologic procedures at Stanford University Hospital between January 2009 and June 2016 were included (n = 13,479). Cases were divided into 2 cohorts: overlapping (n = 1806, 13.4%) vs nonoverlapping (n = 11,673, 86.6%). Variables reviewed were type of operation performed, multidisciplinary team involvement, complications, reoperations, readmissions, and deaths.Results: The total complication rate over 7.5 years studied was 3.3% (n = 450). Complication rates were lower for overlapping cases (0.77%) compared to nonoverlapping cases (3.73%) with an odds ratio of 0.2014, which was statistically significant (P < .0001). When examined by subspecialty, the complication rate for rhinology and endoscopic skull base procedures was approximately 10 times lower when overlapping (0.30%) was compared to nonoverlapping (3.15%), with an odds ratio of 0.094 (P = .0001). There was no difference in complication rates for other surgical subspecialties. There were no deaths associated with overlapping surgery. The rate of major complications requiring reoperation was similarly lower for overlapping procedures (0.276%) compared to nonoverlapping procedures (1.35%) with an odds ratio of 0.2023 (P = .0004). Readmission rates were lower for overlapping cases (0.49%) when compared to nonoverlapping cases (1.09%), with an odds ratio of 0.4553 (P = .0229).Conclusions: Patients undergoing overlapping surgery had lower overall complication rates, lower reoperation rates, lower readmission rates, and no mortalities. The institutional experience presented provides evidence that with appropriate patient and case selection, otolaryngologists may safely perform overlapping surgery without increased risk of adverse patient outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Overlapping surgery (OS) refers to when an attending surgeon supervises two surgeries at the same time with noncritical portions of both surgeries occurring simultaneously. Limited literature reviewing OS exists in orthopaedics. Our goal is to provide insight into this practice across orthopaedic subspecialities to inform its future utilization., Methods: A review of the literature was conducted after Preferred Reporting Items for Systematic Reviews and Meta-Analyses systematic review guidelines. All articles (630 total) were independently reviewed by two authors with a third to resolve discrepancies. Inclusion criteria encompassed any journal publication that included data on a series of orthopaedic OS. Data points sought included the type of surgery, quantity of cases, case duration, overlap time, perioperative complications, and cost., Results: Eleven articles met the inclusion criteria, encompassing a total of 34,494 overlapping surgeries. The studies varied regarding setting and subspecialties included. Six studies demonstrated increased surgical times for overlap cases. Two studies found that although OS increased cost per case, it improved the overall efficiency. Ten studies tracked short-term outcomes (<90 days) and reported no increase in complications with OS. Only one study examined long-term outcomes (1 year) and found a markedly increased risk for surgical complications with OS, with higher complication rates among nonelective compared with elective cases., Discussion: Current literature suggests that OS may increase surgical time, but from the 11 articles reviewed, only one demonstrates an increase in perioperative complications across orthopaedic subspecialities. OS also seems to increase costs per case; however, this is offset by the ability to perform more cases in the same period, resulting in an overall increase in the net profit. These data are consistent with studies from other surgical specialties., Conclusion: Although OS seems to be both safe and effective, future investigations are needed to understand the impact it has on patients and healthcare systems., (Copyright © 2023 by the American Academy of Orthopaedic Surgeons.)

Overlapping surgery, performed by the same primary attending surgeon asynchronously, has gained significant attention from the government and media as potentially harmful to patients. Therefore, the goal of this study was to evaluate the outcomes and safety of overlapping versus nonoverlapping microvascular decompression (MVD) operations. Patients who underwent MVD operations were retrospectively reviewed: 1153 with hemifacial spasm (HFS), 694 (60.2%) of whom underwent overlapping procedures, and 935 with trigeminal neuralgia (TN), 612 (65.5%) of whom underwent overlapping procedures. Collected variables included patient age, sex, side, disease duration, clinical characteristic, comorbidity, affected vessel, intraoperative neuroelectrophysiology, operation time under microscope, total surgical procedure times, mean length of stay (LOS), efficacy (at discharge, 6 months, 1 year), short-term complications, and long-term complications. χ2 and t tests were performed to compare overlapping versus nonoverlapping cases, and then multivariate analysis were conducted to adjust for patient demographics, clinical characteristics, and comorbidity between the 2 groups. Patient variables (age, sex, side, disease duration, clinical characteristic, and comorbidity), affected vessel, and intraoperative neuroelectrophysiology were similar between the 2 groups. After adjustment for patient demographics, clinical characteristics, and comorbidity, overlapping surgeries had longer total surgical procedure times (HFS: standardized coefficient = 0.066, P < 0.05; TN: standardized coefficient = 0.086, P < 0.05). Overlapping surgery was not associated with a significant difference in operation time under microscope, mean LOS, efficacy (at discharge, 6 months, 1 year), short-term complications, and long-term complications. Overlapping MVD operations may be performed safely at our institution. Further prospective studies are needed to understand the association of overlapping surgery among MVD operations. [ABSTRACT FROM AUTHOR]

We study the widespread practice of assigning a single surgeon to two operating rooms (ORs), which is known as overlapping surgery. We first describe the fundamental trade‐offs that motivate hospitals to employ the practice. Then, we conduct a mathematical analysis for the completion of a set of elective operations under an overlapping surgery policy and a more traditional, serial scheduling policy. We use this analysis, along with a cost function that considers surgeon idle time and total OR time, to derive two models for predicting environments where overlapping surgery is preferable. We use insights from our modeling efforts to provide objective evidence that supports or opposes claims made in the medical trade literature regarding the use of overlapping surgery. In particular, we show that contrary to claims in the medical trade literature, overlapping surgery does not allow a hospital to increase total surgical volume. Finally, we show that hospitals interested in employing overlapping surgery are best served by focusing efforts aimed at reducing time requirement uncertainty on turnover times instead of procedure times. [ABSTRACT FROM AUTHOR]

Objective: Determine the safety of overlapping surgery in a tertiary care colorectal surgery practice. Summary: Although overlapping surgery is common in academic centers, reports on outcomes of this practice are limited. The primary aim of this study was to investigate the safety of overlapping surgery in a dedicated tertiary care academic colorectal practice by comparing groups of patients who did or did not have their surgery performed in an overlapping fashion. Methods: Retrospective review of 1270 colorectal patients undergoing inpatient colorectal surgery at our institution. Eligible participants were all patients undergoing elective inpatient colorectal surgery by one of the colorectal surgeons at the Mayo Clinic Rochester between January 1, 2012 and December 31, 2015. Patients under the age of 18 or who underwent an emergent procedure were excluded. Data were abstracted using the American College of Surgeons National Quality Improvement Program (ACS-NSQIP) database. Additionally, each subject's chart was reviewed and further abstracted. The safety of overlapping surgery on outcomes was assessed using multiple multivariable models. Results: One thousand two hundred seventy patients were included in the study cohort of whom 50.7% were female and the average age was 55.4 years. Overlapping surgery occurred in 576 patients (45%). There were no significant differences in demographic, surgical indications, procedures, or operative complexity between patients undergoing overlapping surgery and those who did not. Overall adverse events were significantly less likely in patients undergoing overlapping surgery compared with those who did not (18.4% vs 23.6%, P = 0.02). We found that overlapping surgery was associated with significantly less adverse events compared with patients not undergoing overlapping surgery using a model that controlled for the effect of the individual surgeon (OR 0.7, 95% CI 0.6 – 0.96; P  = .02) and a multivariable propensity score (OR 0.7, 95% CI 0.5– 0.9; P = 01). Conclusions: Overlapping surgery in a tertiary care colorectal practice is safe and not associated with adverse patient outcomes. [ABSTRACT FROM AUTHOR]

Objectives: To explore patient opinions and underlying values regarding overlapping surgery (OS) scenarios, specifically evaluating the effect of attending surgeon presence and availability, as well as trainee participation on patient comfort level and willingness to consent.Study Design: Mixed methods.Methods: Forty adults participated in semi-structured interviews. Interviews included vignettes involving three scenarios of OS (1: attending present; 2: attending absent for wound closure; 3: attending absent and unavailable for wound closure, with covering attending), visual analog scale ratings of participants' comfort with scenarios, and cognitive debriefing. Themes and subthemes were identified using hierarchical coding of transcripts, and quantitative and qualitative analyses were conducted.Results: Quantitative analysis revealed anticipated decreases in comfort with decreasing attending presence/availability (mean comfort level 94% vs. 78% vs. 63% for scenarios 1 vs. 2 vs. 3, P < 0.005), although many patients reported improved comfort with scenario 3 if meeting the covering attending. Participants demonstrated a preference for less trainee involvement (P < 0.005, scenario 1) and greater trainee experience (P < 0.05, all scenarios). However, not all individuals were uncomfortable with attending absence or trainee independence. Themes important for decision making included trust in the surgeon, surgeon experience, trainee involvement, disease severity, cost, and wait time.Conclusion: Patients varied highly in their willingness to consent to OS scenarios. In settings of trainee independence and covering surgeons, many patients desired meeting these members of the treatment team, which improved comfort for some. For some patients, tradeoffs and incentives of timeliness, cost, and convenience modified their willingness to have OS.Level Of Evidence: 4 Laryngoscope, 129:1337-1346, 2019. [ABSTRACT FROM AUTHOR]

Abstract As a special type of dispersion element, a curved prism features high efficiency and no overlapping spectra, but suffers from nonlinear dispersion caused by the characteristics of the material. This paper proposes a design method for a nonlinearity-corrected spectrometer combining glass and optical plastic. We theoretically analyze the dispersion characteristics of the curved prism by using the method of equivalent triangular prism based on the theory of vector solving. This analysis is used to calculate the initial parameters for pairs of prisms. The method features simplified calculation, and the design achieves the benefits of compactness and light weight. The simulation results show that the spectral resolution varies from 4.9 to 7.1 nm in a wide spectrum (400–1000 nm); the nonlinearity ratio is nearly 1:2, making the dispersion across the wide spectrum nearly homogenized; and the spectral keystones and smiles of the system are less than 0.15 pixels. Under the same specifications, the weight of a combination of glass and optical plastic apparently decreases compared to that of the design with glass alone. The results demonstrate that the nonlinearity of the prism spectrometer is corrected to a large extent and merits such as light weight, compactness, and high throughout are achieved. This method can be applied to the field of biological detection, such as in a microscopic spectrometer. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study was to evaluate the efficiency and safety of overlapping surgery (OS) at a training institution by comparing it with nonoverlapping surgery (NO) with respect to operative time, mortality, readmissions, and complications. Background: OS is the practice of an attending physician providing supervision to 2 surgeries that are scheduled at overlapping times. Recent media and government attention have raised concerns about this practice and the need for informed patient consent. Methods: A population-based, retrospective, cohort study was conducted using data on operative procedures from January 1, 2014 to December 31, 2015 at a large tertiary academic center. Patients who had undergone surgery by attending surgeons who performed ≥10% of their cases overlapping were selected. Thirty-day mortality, readmission within 30 days, and 7 patient safety indicators (PSIs) were recorded. Results: A total of 26,260 cases met our criteria for analysis for surgical time and 15,106 cases for outcomes. OS patients had an average case length of 2.18 hours compared with 1.64 hours among NO patients (P < 0.0001), a decreased risk of mortality [relative risk (RR) 0.42, 95% confidence interval (CI), 0.34–0.52, P < 0.0001), a decreased risk of readmission (RR 0.92, 95% CI, 0.86–0.98, P = 0.0148), and a decreased risk of experiencing any PSI (RR 0.67, 95% CI, 0.55–0.83, P = 0.0002). Conclusions: The present study confirms prior reports and addresses gaps in the literature regarding OS, such as the effect of resident involvement and the individual effect of OS in 13 different surgical specialties. The findings highlight the need for additional investigation and suggest that the practice of OS does not expose patients to increased risk of negative outcomes. [ABSTRACT FROM AUTHOR]

Importance: Overlapping surgery, in which more than 1 procedure performed by the same primary surgeon is scheduled so the start time of one procedure overlaps with the end time of another, is of concern because of potential adverse outcomes.Objective: To determine the association between overlapping surgery and mortality, complications, and length of surgery.Design, Setting, and Participants: Retrospective cohort study of 66 430 operations in patients aged 18 to 90 years undergoing total knee or hip arthroplasty; spine surgery; coronary artery bypass graft (CABG) surgery; and craniotomy at 8 centers between January 1, 2010, and May 31, 2018. Patients were followed up until discharge.Exposures: Overlapping surgery (≥2 operations performed by the same surgeon in which ≥1 hour of 1 case, or the entire case for those <1 hour, occurs when another procedure is being performed).Main Outcomes and Measures: Primary outcomes were in-hospital mortality or complications (major: thromboembolic event, pneumonia, sepsis, stroke, or myocardial infarction; minor: urinary tract or surgical site infection) and surgery duration.Results: The final sample consisted of 66 430 operations (mean patient age, 59 [SD, 15] years; 31 915 women [48%]), of which 8224 (12%) were overlapping. After adjusting for confounders, overlapping surgery was not associated with a significant difference in in-hospital mortality (1.9% overlapping vs 1.6% nonoverlapping; difference, 0.3% [95% CI, -0.2% to 0.7%]; P = .21) or risk of complications (12.8% overlapping vs 11.8% nonoverlapping; difference, 0.9% [95% CI, -0.1% to 1.9%]; P = .08). Overlapping surgery was associated with increased surgery length (204 vs 173 minutes; difference, 30 minutes [95% CI, 24 to 37 minutes]; P < .001). Overlapping surgery was significantly associated with increased mortality and increased complications among patients having a high preoperative predicted risk for mortality and complications, compared with low-risk patients (mortality: 5.8% vs 4.7%; difference, 1.2% [95% CI, 0.1% to 2.2%]; P = .03; complications: 29.2% vs 27.0%; difference, 2.3% [95% CI, 0.3% to 4.3%]; P = .03).Conclusions and Relevance: Among adults undergoing common operations, overlapping surgery was not significantly associated with differences in in-hospital mortality or postoperative complication rates but was significantly associated with increased surgery length. Further research is needed to understand the association of overlapping surgery with these outcomes among specific patient subgroups. [ABSTRACT FROM AUTHOR]

Study Design: Prospective cross-sectional survey.Objective: To determine the perspectives of parents of patients undergoing posterior instrumented fusion for adolescent idiopathic scoliosis (AIS) regarding simultaneous surgery and trainee participation.Summary Of Background Data: Simultaneous ("at the same time") surgery is under scrutiny by the public, government, payers, and the medical community. The objective of this study is to determine the perspectives of parents of patients undergoing posterior instrumented fusion for adolescent idiopathic scoliosis. Our goal is to inform the national conversation on this subject with real patient and family voices.Methods: A survey was prospectively administered to 31 consecutive parents of patients undergoing posterior instrumented fusion for adolescent idiopathic scoliosis at a large academic medical center. "Overlapping" was defined as simultaneity during "noncritical" parts of an operation. "Concurrent" was defined as simultaneity that includes "critical" part(s) of an operation. Participants were asked to provide levels of agreement with overlapping and concurrent surgery and anesthesia, as well as with trainee involvement.Results: On average, respondents "strongly agree" with the need to be informed about overlapping or concurrent surgery. They "disagree" with both overlapping and concurrent scheduling, and "disagree" with trainees operating without direct supervision, even for "noncritical" parts. Informing parents about the presence of a back-up surgeon or research demonstrating safety of simultaneous surgery did not make them agreeable to simultaneous scheduling.Conclusion: Parents have a strong desire to be informed of simultaneous spinal surgery and anesthesia as part of consent on behalf of their children. Their disagreement with simultaneous surgery, as well as with trainees operating without direct supervision, suggests discordance with current guidelines and practice and should inform the national conversation moving forward.Level Of Evidence: N/A. [ABSTRACT FROM AUTHOR]

Background: Many surgeons utilize assistants to perform procedures in more than one operating room at a given time using a practice known as overlapping surgery. Debate has continued as to whether overlapping surgery improves the efficiency and access to care or risks patient safety and outcomes. Objective: To examine effects of overlapping surgery in deep brain stimulation (DBS) for movement disorders. Methods: In this retrospective analysis of overlapping and non-overlapping cases, we evaluated stereotactic accuracy, operative duration, length of hospital stay, and the presence of hemorrhage, wound-related complications, and hardware-related complications requiring revision in adults with movement disorders undergoing DBS. Results: Of 324 cases, 141 (43.5%) were overlapping and 183 (56.5%) non-overlapping. Stereotactic error, number of brain penetrations, and postoperative length of hospitalization did not differ significantly (p ≥ 0.08) between the overlapping and non-overlapping groups. Mean operative duration was significantly longer for overlapping (81/141 [57.4%], 189.5 ± 10.8 min) than for non-overlapping cases (79/183 [43.2%], 169.9 ± 7.6 min; p = 0.004). There were no differences in rates of wound-related complications or hemorrhages, but overlapping cases had a significantly higher rate of hardware-related complications requiring revision (7/141 [5.0%] vs. 0/183 [0%]; p = 0.002). Conclusions: Overlapping and non-overlapping cases had comparable DBS lead placement accuracy. Overlapping cases had a longer operative duration and had a higher rate of hardware-related complications requiring revision. [ABSTRACT FROM AUTHOR]

The objective of this study was to investigate the alterations in morphology and aerobic resistance of rats subjected to different physical training protocols. The study consisted of 55 rats of the "Wistar" breed, 100 days of age, over a period of 8 weeks. The animals were randomly distributed between four groups: control (CTLE); neuromuscular anaerobic (TAN); aerobic (TAE) and concurrent training (TCc). After four weeks, some of the animals were euthanized. The body mass index (BMI), Lee index (Lee), epididymal adipose tissue (TecAdp), body weight, and feed efficiency ratio (CoefAlim) were measured. The Anaerobic Threshold was determined by critical workload (7%, 9% and 11% of body weight). TAE and TCc training caused alterations in Lee and BMI, at four and eight weeks respectively (LeeTAE=X:2.86±0.08; X:2.89±0.07 and LeeTCc=X:2.85±0.05; X:3.00±0.09). For the TecAdp, all groups presented a decrease, with the TCc value down after eight weeks (X:1.77±0.32). Finally, TAN training improved the CoefAlim (X:31.57±3.70) after the eight week period and the TCc presented the highest value for Lan (X:7.10±0.80). [ABSTRACT FROM AUTHOR]

In this paper, a queueing system with multicast service, random resource requirements and general probability distributions of busy and idle periods is considered. Motivated by challenges from practical applications in the area of performance analysis of telecommunication systems, the model is built on the basis of well-known resource queueing systems theory. Two distinctive features of the model related to resource requirements are: the volume of a requirement, which is random with a given probability distribution function, and the resource requirements which overlap with each other. The first feature comes from the analysis of wireless networks, where the volume of resource depends on the location of the mobile equipment, type of telecommunication service, required data bitrate and radio signal path loss. The second feature relates to the multicast approach to data delivery in modern telecommunication networks. The stationary probability distribution of the number of customers in the system is derived. The main characteristics for the performance analysis of multicast telecommunication systems including the blocking probability, the mean number of customers in the system and the mean of the total amount of occupied resources are proposed. The analytical formulas for the performance calculations are obtained for the Fréchet-type distribution of a requested resources volume. [ABSTRACT FROM AUTHOR]

This Special Issue of Cognition and Emotion addresses one of the cardinal concerns of affective science, which is overlapping and distinctive features of anxiety and depression. A central finding in the study of anxiety and depression is that they are moderately highly correlated with each other. This leads us to the question: What is behind this co-occurrence? Possible explanations relate to poor discriminant validity of measures; both emotional states are associated with negative affect; stressful life events; impaired cognitive processes; they share a common biological/genetic diathesis. However, despite a set of common (nonspecific) features, anxiety and depression are clearly not identical emotional states. Differences between them might be best viewed, for example, through their heterogeneous and multi-layered nature, adaptive functions and relations with regulatory processes, positive affect, and motivation or complex cognitive processes. In this introduction we consider several approaches (e.g. functional approach; tripartite model and content-specificity hypothesis) to which most research in this Special Issue is relevant. In addition, we have asked contributors to this Special Issue to indicate how their own studies on comparisons between anxiety and depression and models on anxiety and depression move this area of research to more mature science with applicability. [ABSTRACT FROM AUTHOR]

We analyzed 356 patients with idiopathic sudden sensorineural hearing loss treated with hyperbaric oxygen therapy and systemic steroids (n = 161), systemic steroids alone (n = 160), or intratympanic and systemic steroids (n = 35). The main outcome measure was the hearing recovery rate. The effect of other variables, including the initial averaged 5-frequency hearing level, patient age, interval between the onset of symptoms and treatment, presence of vertigo as a complication, presence of diabetes mellitus, smoking history, and presence of hypertension, on the hearing recovery rate was also evaluated. The overall hearing recovery rate was significantly higher for the patients treated with hyperbaric oxygen therapy and systemic steroids than for those treated with systemic steroids alone (p < 0.001) or systemic and intratympanic steroids (p < 0.001). The presence of vertigo negatively affected hearing recovery. Our findings suggest that hyperbaric oxygen therapy confers a significant additional therapeutic benefit when used in combination with steroid therapy for idiopathic sudden sensorineural hearing loss. [ABSTRACT FROM AUTHOR]

Background: Concurrent opioid and benzodiazepine use is associated with a three-fold increase in the risk of opioid-related overdose. No study has evaluated geographic variation in the concurrent use of opioids and benzodiazepines in US Medicare. We compared state, hospital-referral region (HRR), and county-level variation in concurrent opioid and benzodiazepine use among US Medicare opioid users and examined the heterogeneity in concurrent use within states.Methods: Using 2013-2014 US Medicare Part D claims, we identified non-cancer beneficiaries who used opioids in 2014 (n = 268,678). The outcome was concurrent opioid and benzodiazepine use. We constructed logistic regression models to isolate state, HRR, and county-level variation not explained by patient characteristics, and evaluated how county and HRR quintiles are distributed within state quintiles.Results: The adjusted probability of concurrent use ranged from 16.7%-29.6% across states, 12.1%-37.0% across HRRs, and 0%-65.2% across counties. State-level variation masks substantial county-level variation: only 18% of counties located in the lowest state quintile were in the lowest county quintile, and only 23% of counties located in the highest state quintile were in the highest county quintile. We also observed variation in concurrent use across HRRs within states, but it was not as dispersed. For example, 52% of the HRRs located in the highest state quintile were in the highest HRR quintile.Conclusions: Large variation in concurrent use of opioids and benzodiazepines exists across the US. State variation masks substantial local variation, which beckons for polices to monitor concurrent opioid and benzodiazepine use at the county level. [ABSTRACT FROM AUTHOR]

The task of segmenting cell nuclei and cytoplasm in pap smear images is one of the most challenging tasks in automated cervix cytological analysis due to specifically the presence of overlapping cells. This paper introduces a multi-pass fast watershed-based method (MPFW) to segment both nucleus and cytoplasm from large cell masses of overlapping cervical cells in three watershed passes. The first pass locates the nuclei with barrier-based watershed on the gradient-based edge map of a pre-processed image. The next pass segments the isolated, touching, and partially overlapping cells with a watershed transform adapted to the cell shape and location. The final pass introduces mutual iterative watersheds separately applied to each nucleus in the largely overlapping clusters to estimate the cell shape. In MPFW, the line-shaped contours of the watershed cells are deformed with ellipse fitting and contour adjustment to give a better representation of cell shapes. The performance of the proposed method has been evaluated using synthetic, real extended depth-of-field, and multi-layers cervical cytology images provided by the first and second overlapping cervical cytology image segmentation challenges in ISBI 2014 and ISBI 2015. The experimental results demonstrate superior performance of the proposed MPFW in terms of segmentation accuracy, detection rate, and time complexity, compared with recent peer methods. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the incidence and trends of 30-day outcomes after concurrent surgeries for gynecologic cancer and pelvic floor disorders.Methods: Using the American College of Surgeons National Quality Improvement Program database, patients who underwent surgery for gynecologic cancer with and without pelvic floor reconstruction were identified between the years 2013 and 2016. Propensity score matching was performed to ameliorate selection. Student t test and Mann-Whitney tests were used to compare continuous variables between two groups where appropriate. The χ and Fisher exact tests were used where appropriate to compare categorical variables across groups. Logistic regression models were used to evaluate factors associated with any adverse event and with postoperative transfusion specifically.Results: Twenty-five thousand one hundred thirty-eight patients underwent oncologic surgery and 589 (2.3%) of these had concurrent pelvic reconstruction during the study period. After propensity matching, there were 488 combined cases; 976 oncologic-only cases were selected as controls. There were no statistically significant differences across any of the baseline characteristics between groups. Although more common in the combined than in the control cohort, the incidence of any postoperative adverse event (8.2% vs 5.5%, odds ratio [OR] 1.5, 95% CI 0.99-2.3) was not statistically significant between groups. Postoperative blood transfusions, however, were more common in the combined cohort than in the control cohort (7.2% vs 3.6%, OR 1.7, 95% CI 1.1-2.8). After logistic regression, ovarian cancer (adjusted OR 7.9, 95% CI 4.9-12.7) and prolapse surgery (adjusted OR 1.7, 95% CI 1.0-2.7) remained significantly associated with any postoperative adverse events. Similarly, ovarian cancer (adjusted OR 10.0, 95% CI 5.9-17.3) and prolapse surgery (adjusted OR 2.1, 95% CI 1.2-3.6) remained significantly associated with a higher incidence of postoperative blood transfusions.Conclusion: Combined reconstructive and oncologic surgery is associated with a low but statistically significant increase in the risk of any postoperative adverse event and specifically blood transfusions. [ABSTRACT FROM AUTHOR]