In Reply: Overlapping Surgeries are not Associated With Worse Patient Outcomes: Retrospective Multivariate Analysis of 14 872 Neurosurgical Cases Performed at a Single Institution

To the Editor: We appreciate the comments of the authors1 and the excellent point they raise in regards to our article.2 Interestingly, recently published data have shown that more restrictive overlapping surgery policies not only have no impact on overall and serious complication rates but also significantly decrease resident involvement in neurosurgical procedures and significantly lengthen patient wait times for elective neurosurgical procedures.3 Although the best evidence to date on overlapping surgery is retrospective, the data increasingly suggest that restricting overlapping surgery results in no benefit to surgical outcomes and wide-ranging potential harm to current and future surgical patients. The difficulty of designing and executing a prospective randomized trial with so many variables is a daunting and very costly undertaking and, I suspect, difficult to execute. Disclosure The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article.