Introduction: Concurrent surgery—the performance of two or more surgical procedures at the same time by a single lead surgeon—has recently come under intense scrutiny, although data on the effects of concurrent procedures on patient outcomes are lacking. We examined the impact of concurrent surgery on complication rates in neurosurgical patients.

Methods: We conducted a retrospective review of consecutive, non-emergent neurosurgical procedures performed from May 12, 2014, to May 12, 2015, by any of the five senior neurosurgeons at our institution authorized to schedule concurrent cases. Concurrent surgery was defined as any case where two patients were under anesthesia at the same time under the care of a single lead surgeon for any duration. Information on patient demographics, premorbid conditions, surgical variables, and postoperative course were analyzed. Primary outcome was the occurrence of any complication from the beginning of surgery to 30 days after discharge. The secondary outcomes was the occurrence of a serious complication—defined as a life-threatening or life-ending event—during this period.

Results: One thousand eighteen patients met inclusion criteria for the study. Of these, four hundred seventy-five patients underwent concurrent surgery (46.7%). Two-hundred seventy-one patients (26.6%) experienced one or more complications, with 134 (13.2%) suffering a serious complication. The overall complication rate was not significantly higher for concurrent cases compared with non-concurrent cases (26.3% vs. 26.9%, p=0.837) nor was the rate of serious complications (14.7% vs. 11.8%, p=0.168). On multivariable analysis, concurrent surgery remained unassociated with overall complications (odds ratio 0.810; 95% confidence interval 0.592–1.109, p=0.189) or serious complications (odds ratio 0.979; 95% confidence interval 0.661–1.449, p=0.915).

Conclusions: In this cohort, patients undergoing concurrent surgery were not at increased risk for overall complications or serious complications. Although this suggests that concurrent surgery may be performed safely within the appropriate framework, further investigation is needed in other specialties and at other institutions.

Patient Care: Concurrent surgery is commonly utilized at a number of academic medical centers nationwide, and plays an important role in patient care at these institutions. Our research investigates the impact of this practice on complications in the neurosurgical population, and represents the first study on this topic. This information may lead to more informed decision making when developing policies related to concurrent surgery, thus improving the management of these patients.

Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the importance of an appropriate framework for managing concurrent neurosurgical procedures. 2) Describe, in small groups, the current controversy in concurrent surgery. 3) Identify an effective intervention for ensuring concurrent surgery safety.

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