Abstract
Abstract
INTRODUCTION
Many surgeons utilize assistants to perform procedures in more than one operating room at a given time, a practice known as overlapping surgery. This single-surgeon retrospective analysis examines the effect of overlapping surgery on clinically relevant endpoints in deep brain stimulation (DBS) surgery for movement disorders.
METHODS
DBS electrode placements performed by the primary surgeon at the Barrow Neurological Institute were retrospectively evaluated. Recorded case times for each DBS surgery were evaluated for any overlap with another case of the primary surgeon on the same day. Stereotactic accuracy, operative duration, length of hospital stay, and rates of hemorrhage, wound-related complications, and hardware-related complications requiring a revision (eg, postoperative high impedance) were noted and compared between overlapping and nonoverlapping cases.
RESULTS
Of 324 cases, 141 were overlapping and 183 were nonoverlapping. Stereotactic error, the number of brain penetrations per electrode, and postoperative length of stay did not differ significantly between overlapping and nonoverlapping cases. There was also no significant difference when “asleep” DBS cases were considered as a separate subgroup. Mean operative duration was significantly longer in overlapping cases for the most common permutation of the procedure (asleep, bilateral electrode placement with a pulse generator; 190 min vs 170 min, P = .004). Hemorrhage and wound-related complication rates did not differ significantly, but the rate of hardware-related complications requiring revision was significantly higher in the overlapping group (7/141 vs 0/183; P = .002).
CONCLUSION
Stereotactic accuracy, brain penetration, hospital length of stay, hemorrhage rates, and wound-related complication rates were comparable for overlapping and nonoverlapping DBS electrode placements. Overlapping DBS electrode placements had a longer operative duration and demonstrated a higher rate of hardware-related complications requiring revision. Overlapping DBS surgery can be performed safely and accurately but attention to detail remains critical for optimal outcomes for this elective procedure.