Outcomes and Safety of Overlapping Surgery in Patients Undergoing Microvascular Decompression for Hemifacial Spasm and Trigeminal Neuralgia

Abstract

Overlapping surgery, performed by the same primary attending surgeon asynchronously, has gained significant attention from the government and media as potentially harmful to patients. Therefore, the goal of this study was to evaluate the outcomes and safety of overlapping versus nonoverlapping microvascular decompression (MVD) operations. Patients who underwent MVD operations were retrospectively reviewed: 1153 with hemifacial spasm (HFS), 694 (60.2%) of whom underwent overlapping procedures, and 935 with trigeminal neuralgia (TN), 612 (65.5%) of whom underwent overlapping procedures. Collected variables included patient age, sex, side, disease duration, clinical characteristic, comorbidity, affected vessel, intraoperative neuroelectrophysiology, operation time under microscope, total surgical procedure times, mean length of stay (LOS), efficacy (at discharge, 6 months, 1 year), short-term complications, and long-term complications. χ2 and t tests were performed to compare overlapping versus nonoverlapping cases, and then multivariate analysis were conducted to adjust for patient demographics, clinical characteristics, and comorbidity between the 2 groups. Patient variables (age, sex, side, disease duration, clinical characteristic, and comorbidity), affected vessel, and intraoperative neuroelectrophysiology were similar between the 2 groups. After adjustment for patient demographics, clinical characteristics, and comorbidity, overlapping surgeries had longer total surgical procedure times (HFS: standardized coefficient= 0.066, P < 0.05; TN: standardized coefficient= 0.086, P < 0.05). Overlapping surgery was not associated with a significant difference in operation time under microscope, mean LOS, efficacy (at discharge, 6 months, 1 year), short-term complications, and long-term complications. Overlapping MVD operations may be performed safely at our institution. Further prospective studies are needed to understand the association of overlapping surgery among MVD operations.