1370. Association of Surgical Overlap During Wound Closure with Patient Outcomes Amongst Neurological Surgery Patients at a Large Academic Medical Center

Authors: Neil R. Malhotra, MD, FAANS; Gregory Glauser, BS; Prateek Agarwal; Ashwin Ramayya, MD, PhD; H. Isaac Chen, MD; John Lee, MD; James Schuster, MD, PhD; Benjamin Osiemo, MS; Stephen Goodrich, BS; Lachlan Smith, PhD; Scott McClintock, PhD (Philadelphia, PA)

Introduction: Several studies have explored the effect of overlapping surgery on patient outcomes but impact of surgical overlap during wound closure has not been studied. We sought to examine the association of overlap during wound closure, suture time overlap (STO), with patient outcomes in a heterogeneous neurosurgical population.
Methods: Over four years (7/2013-7/2017), 17689 neurosurgical procedures were retrospectively reviewed at a single, multi-hospital academic medical center. Suture time overlap (STO) was defined as all surgeries for which an overlapping surgery occurred, exclusively, during wound closure of the index case being studied.  We excluded non-elective cases and overlapping surgeries that involved overlap during surgical portions of the case other than wound closure. Tests of independence and Wilcoxon tests were used to assess patient demographics, health status at baseline, outcome measures, and complication rates.
Results: Patients with STO had shortened length of hospital stay (100.6 vs 135.1 hours; p<0.0001), reduced deaths in follow-up (1.59% vs 5.45%; p = 0.0004), and lower 30 to 90-day readmission rate (3.64% vs 7.47%; p = 0.0026). Patients with STO were less likely to receive prophylactic powdered antibiotics in the wound at closure (19.4% vs 33.4%; p<0.0001) but had no increase in revision surgery. Patients with STO had longer wound closure times (26.5 vs 23.9 min; p<0.0001), however, had shorter total surgical times (non-closure surgical time 101.8 vs 133.3 min; p<0.0001 and total surgical time 128.3 vs 157.1 min; p<0.0001). We did not observe differences in gender, age, measures of patient co-morbidity (ASA scores, CCI score, CCI predicted 10-year survival rate), prior surgery, discharge status, or 30-day readmission or reoperation rates. Conclusion: Surgical overlap during wound closure (STO) is associated with improved or at least non-inferior patient outcomes as it pertains to readmissions and wound revisions.