Overlapping surgery in arthroplasty – a systematic review and meta-analysis

• Published in: Orthopaedics & traumatology, surgery & research surgery & research, 2023-06, Vol.109 (4), p.103299-103299, Article 103299
• Main Authors: Kim, Raymond G., An, Vincent V.G., Lee, Sun Loong K., Khadra, Sam M., Petchell, Jeffrey F.
• Format: Article
• Language: English
• Subjects: Arthroplasty; Arthroplasty, Replacement, Hip - methods; Arthroplasty, Replacement, Knee - adverse effects; Arthroplasty, Replacement, Knee - methods; Complications; Humans; Length of Stay; Overlapping surgery; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Preoperative Care; Reoperation; Safety; Total hip arthroplasty; Total knee arthroplasty
• ISSN: 1877-0568; 1877-0568
• DOI: 10.1016/j.otsr.2022.103299

•Managing long waiting lists for highly effective lower limb elective arthroplasties continue to have challenges given the increasing demand for these procedures globally.•The COVID-19 pandemic has postponed elective lower limb arthroplasties and therefore worsened the conditions of patients already on such long waiting lists.•Having schedules of overlapping surgery is one established method to improve efficiency, manage such waiting lists and reduce overall hospital costs.•Concerns about safety have been raised with this type of practice due to decreased levels of supervision and increased responsibility of the surgical team.•Our study demonstrated no difference in postoperative adverse events for elective total hip arthroplasties and total knee arthroplasties performed on non-overlapping or overlapping surgery schedules. Planned overlapping surgery can improve efficiency, reduce costs and help manage long waiting lists; yet, this practice has been questioned due to patient safety concerns. A systematic review and meta-analysis were performed to answer the question: (1) are there any differences in the risk of postoperative adverse outcomes; and (2) are there any differences in length of stay or length of surgery, in elective total hip arthroplasty (THA) and total knee arthroplasty (TKA) performed either as non-overlapping surgery (NOS) or overlapping surgery (OS). A systematic search of literature in the databases of MEDLINE, PubMed, Embase and Cochrane from dates of inception was performed. All studies published in English were included. Risk of Bias in Non-randomised Studies–of Interventions (ROBINS-I) and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework were utilised. Relative risk (RR) was used for dichotomous outcomes, while mean difference (MD) was used for continuous variables, with 95% confidence intervals. Alpha was set at 0.05. A total of nine studies with 120,625 patients were included for analyses. There were no statistically significant differences for overall rates of postoperative complications, dislocations, fractures, infections, readmissions or revision surgery nor with length of stay or length of surgery (p>0.05). Patient characteristics between groups were similar (p>0.05). There were no differences in postoperative adverse outcomes for elective orthopaedic THA and TKA performed as NOS when compared to OS. Operating schedules for OS in elective lower limb arthroplasty appear to be safe, given ap