Implementation and clinical impact of a robotic heart surgery program

Planned overlapping surgery can improve efficiency, reduce costs and help manage long waiting lists, yet this practice has been questioned due to patient safety concerns. A systematic review and meta-analysis were performed to answer the question: (1) Are there any differences in the risk of post-operative adverse outcomes and (2) are there any differences in length of stay or length of surgery, in elective total hip arthroplasty (THA) and total knee arthroplasty (TKA) performed either as non-overlapping surgery (NOS) or overlapping surgery (OS).A systematic search of literature in the databases of MEDLINE, PubMed, Embase and Cochrane from dates of inception was performed. All studies published in English were included. Risk of Bias in Non-randomised Studies–of Interventions (ROBINS-I) and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework were utilised. Relative risk (RR) was used for dichotomous outcomes, while mean difference (MD) was used for continuous variables, with 95% confidence intervals. Alpha was set at 0.05.A total of nine studies with 120,625 patients were included for analyses. There were no statistically significant differences for overall rates of post-operative complications, dislocations, fractures, infections, readmissions or revision surgery nor with length of stay or length of surgery (p > 0.05). Patient characteristics between groups were similar (p > 0.05).There were no differences in post-operative adverse outcomes for elective orthopaedic THA and TKA performed as NOS when compared to OS. Operating schedules for OS in elective lower limb arthroplasty appear to be safe, given appropriate patient selection processes and may be a useful method to improve hospital efficiency. Informed consent and pre-operative patient education should remain paramount.IV.