Letter: 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 commend Bohl et al1 for their recent publication. In this interesting paper, the authors demonstrate univariate and multivariate analyses of data for a large cohort of 14 872 consecutive neurosurgical patients to reject the hypothesis that overlapping surgeries are harmful to patients,1 further confirming and strengthening findings from previous studies.2,3 They suggest delegation of operative tasks to residents in overlapping surgeries than in nonoverlapping surgeries, as part of the reason for the better patient outcomes observed in the overlapping procedures, as well as appropriate selection of cases scheduled for overlapping surgeries, the effective delegation of routine surgical tasks to residents, and hence improved surgical outcomes associated with greater resident involvement.1 We would like to add that in addition to the various benefits of overlapping surgeries such as improved patient access to specialist care, decrease in wait times before surgery, and improved education of the next generation of surgeons,2-4 it is also an important and helpful practice for the advancement of daycase neurosurgery, particularly since such practice enables more procedures to be performed during daytime hours when the hospital is fully staffed as they rightly mentioned.1,3 In addition, their study revealed that patients who had overlapping surgeries had a shorter length of stay following surgical procedures, which is also part of the basis for the practice of daycase neurosurgery,5 even in resource-limited settings.1,6 The fairly rapid recovery from neuroanesthesia with remifentanil plus propofol and/or dexmedetomidine commonly used for daycase surgeries would help to maximize outcomes from the practice of overlapping surgery for daycase patients.5,7 This practice will significantly enhance the capacity of ambulatory daycase surgery as a cost-saving strategy in modern neurosurgery.8 However, their study is not only retrospective like other previous studies on overlapping surgeries in the literature2,3 but also single center as these previous studies,2,3 hence lowering its level of evidence. A similarly large but prospective cohort (and preferably multicenter) study would therefore be required to further validate the findings. Disclosure The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article.