When multiple procedures are completed under the same round of anesthesia, patients can experience numerous benefits. The cost of treatment, preparation time, length of hospital stays, and time spent operating can be minimized. While multi-procedural care is not recommended in all circumstances, various studies have highlighted cases in which such care was appropriate and successful, with one benefit being decreased time under anesthesia.
One assumed benefit of multi-procedural care is that it diminishes the amount of time patients spend in surgery and under anesthesia. One study, following 120 patients who received two procedures–one dental, the other of variable type–under the same round of general anesthesia, compared surgical duration with groups who received separate surgeries [1]. A sub-group, consisting of people who received dentistry and third molar extractions, saved an average of 312 minutes by combining the two procedures [1]. Decreased operative time was also reported in a study of patients receiving combined transurethral resection of the prostate (TURP) and inguinal hernia repair [2].
Clinicians do not always save time when combining procedures. An analysis of 1,120 pediatric patients undergoing multiple procedures in a single anesthetic sitting found that surgical time was not reduced when procedures were performed sequentially [3]. However, even if multi-procedural care does not always diminish surgical time, other factors may be more relevant. An analysis of facial plastic surgery patients at an outpatient center found that anesthesia duration was not an accurate indicator of patient mortality and morbidity [4]. Patients who received surgery with general anesthesia for less than 240 minutes had about equal incidences of major morbidity as those who were under general anesthesia for more than 240 minutes [4]. Of course, this finding does not necessarily extend to pediatric settings.
In the case of pediatric patients in the study mentioned above, the time spent operating may not have decreased, but the number of intubations and airway manipulations did [3]. Considering how anesthesia induction and emergence are the two most challenging elements of pediatric anesthesia care, limiting the number of anesthetic encounters a patient has through multi-procedural care can lead to fewer complications [3]. Indeed, various researchers have demonstrated how multi-procedural care can lead to comparable or even greater safety for patients. Meena et al. studied patients who needed surgery to manage their complex acetabular fractures [5]. They found that combined procedures made it easier for surgeons to assess reductions, without increasing patients’ risk of complications [5]. Kaplan et al. followed 15 patients who underwent abdominoplasty with total abdominal hysterectomy [6]. Only one patient reported a major complication, and none experienced pulmonary embolism [6].
Another potential benefit of multi-procedural care is convenience. When possible and safe, combined procedures can reduce patients’ cost of healthcare, parental time burdens for pediatric patients, and travel expenses [3]. Stapleton et al. found that combined dental and third molar extractions saved patients an average of $2,177 [1]. TURP and inguinal hernia repair patients reported lower hospitalization time and cost, as well as greater patient satisfaction when the procedures were performed together [2]. Similar findings were anticipated by the researchers following acetabular fracture repair patients [5].
In several instances, scheduling surgical procedures to be performed in a single anesthetic sitting can be logistically and financially beneficial for patients without compromising safety. Of course, the level of coordination needed to execute multiple procedures is difficult, especially if distinct surgical teams are required. Along with procedure-specific research, logistical feasibility should be a prime consideration for any clinicians considering this approach.
References
[1] M. Stapleton et al., “Combining procedures under general anesthesia,” Pediatric Dentistry, vol. 29, no. 5, p. 397-402, September/October 2007. [Online]. Available: https://pubmed.ncbi.nlm.nih.gov/18027774.
[2] I. Othman and A.-F. Abdel-Maguid, “Combined transurethral prostatectomy and inguinal hernioplasty,” Hernia, vol. 14, p. 149-153, November 2009. [Online]. Available: https://doi.org/10.1007/s10029-009-0575-1.
[3] R. Miketic et al., “Experience with Combining Pediatric Procedures into a Single Anesthetic,” Pediatric Quality and Safety, vol. 4, no. 5, p. e207, September/October 2019. [Online]. Available: https://doi.org/10.1097/pq9.0000000000000207.
[4] N. A. Gordon and M. E. Koch, “Duration of Anesthesia as an Indicator of Morbidity and Mortality in Office-Based Facial Plastic Surgery,” Archives of Facial Plastic Surgery, vol. 8, no. 1, p. 47-53, January 2006. [Online]. Available: https://doi.org/10.1001/archfaci.8.1.47.
[5] U. K. Meena et al., “Can patients with complex acetabular fractures be operated by combined anterior and posterior approaches in a single anesthetic sitting?,“ Journal of Orthopaedic Science, vol. 25, no. 6, p. 1021-1028, November 2020. [Online]. Available: https://doi.org/10.1016/j.jos.2020.01.002.
[6] H. Y. Kaplan and E. Bar-Meir, “Safety of Combining Abdominoplasty and Total Abdominal Hysterectomy: Fifteen Cases and Review of the Literature,” Annals of Plastic Surgery, vol. 54, no. 4, p. 390-392, April 2005. [Online]. Available: https://doi.org/10.1097/01.sap.0000154853.02129.0f.
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