Introduction: Overlapping surgery is a controversial subject in medicine today; however, very few studies examining the outcomes of this practice exist. We analyzed outcomes of patients with ruptured saccular aneurysms treated with microsurgical clipping in a prospectively collected database from the Barrow Ruptured Aneurysm Trial.
Methods: 241 patients with ruptured saccular aneurysms underwent microsurgical clipping in the trial. Patients were separated into overlapping (n = 123) vs. non-overlapping (n = 118) cohorts based on surgical start/stop times. Outcomes at discharge, 6 months, 1 year, 3 years, and 6 years following surgery were analyzed.
Results: Patient variables including age, smoking status, cardiovascular history, Hunt-Hess Grade, Fisher Grade, and aneurysm size were equivalent between the two groups. Aneurysm locations were similar with the exception of more posterior circulation aneurysms in the overlapping group (18/123 vs. 8/118, p = 0.05). Mean length of surgery was 13 minutes longer in the overlapping group (259.3 vs. 246.4 minutes), however, this did not reach statistical significance (p=0.2). Aneurysm obliteration rate at discharge was higher for the overlapping group compared with the non-overlapping group (91.6% vs. 81.9%, p = 0.03). Hospital length of stay, discharge location, and proportions of patients with mRS > 2 at discharge and up to 6 years postoperatively were equivalent. Mean mRS scores, GOS scores, MMSE scores, NIHSS scores, and Barthel ADL Scores at all timepoints showed no statistical differences.
Conclusions: Overlapping cases in the BRAT had higher rates of aneurysm obliteration at discharge and were not associated with worse outcomes on any of the measured outcomes up to 6 years after surgery. These findings should be considered as future guidelines surrounding the practice of overlapping surgery are discussed.
Patient Care: This data should be used to guide future discussions surrounding overlapping surgery policies, which are currently based on professional opinions and anecdotal case reports.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Cite evidence regarding outcomes of overlapping surgery from a prospectively collected database, 2) Discuss the pros and cons of overlapping surgery and consider current and future policies at their own institutions regarding this practice