Concurrent surgeries: What's the line between safe and reckless?

Little research has been done on the practice

Some surgeons have raised patient consent and safety concerns about hospitals' concurrent surgery practices, prompting pushback from the organizations and other doctors, Jenn Abelson, Jonathan Saltzman, Liz Kowalczyk, and Scott Allen report for the Boston Globe.

Concurrent surgeries—in which an attending surgeon is responsible for multiple surgeries in multiple operating rooms at the same time for at least a portion of the procedures—are a fairly common practice and are permitted at many teaching hospitals, according to the Globe.

Proponents say that such "double-booking" allows hospitals to reduce wait times and have their most in-demand surgeons do more procedures, particularly during daytime hours.

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Meanwhile, teaching hospitals can use the practice to give residents graduated responsibility for components of surgeries. And in some instances, such as in trauma care, proponents say overlapping surgeries can be necessary to care for clusters of emergency and urgent cases.

However, the Globe notes that little scientific research has been done on concurrent surgeries. And opponents of the practice have two main concerns:

  • Multiple surgeries overseen by the same attending that overlap for extended periods of time, as opposed to cases that only have short overlaps at the beginning and end of surgeries; and
  • Insufficient patient consent about concurrent surgeries.

Safety concerns

According to the Globe, "There is no consensus among top doctors about which procedures can safely overlap, and how much overlap is appropriate." Some hospitals have placed more limits on the practice than others, while some have banned it all together.

For instance, Brigham and Women's Hospital prohibits surgeries with the same attending from running simultaneously for more than an hour except in cases of emergency, at which point the surgeon responsible is required to have a "second attending surgeon immediately available," says Michael Zinner, Brigham's chief of surgery.

However, other hospitals permit concurrent surgeries to take place in certain cases for more extended periods of time, the Globe reports. Some of those hospitals do require attending surgeons who are double-booked to be immediately available if there are problems or to designate a backup attending if needed.

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But that has not stopped some doctors from expressing concern about the safety of the practice. For instance, Zinner says that having a surgeon be responsible for two procedures that overlap extensively is "not the right thing to do," adding, "When I am in an OR and focusing on three square inches, bombs can be going off around me, and I am focused on three square inches."

Others have raised issue with patients being under anesthesia for extended periods while an attending surgeon is working on a different concurrent case.

At the same time, several leaders of hospitals defended concurrent surgeries to the Globe. Massachusetts General Hospital President Peter Slavin said that the organization has not "found a single case where the concurrency has caused harm, so I don't think patients should be alarmed about it."

Consent concerns

Meanwhile, some say that hospitals have an obligation to tell patients that their surgeon will also be overseeing another procedure at the same time.

George Annas, a patients' right advocate at Boston University School of Public Health, says, "For the doctor to get informed consent, you have to tell the patient anything that's material about their surgery, and 'material' is defined as what might cause a patient to change his or her mind, to say, 'I don't want surgery.'"

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"I think it's a fact that most patients would be uncomfortable with their doctor doing two operations simultaneously," Annas adds.

One hospitals' patient consent form obtained by the Globe noted said that "my doctor or an attending designee" will be in the OR for all the critical parts of the surgery. However, the hospital does not require that patients be told if a surgeon will be overseeing multiple cases at the same time (Abelson et al., Boston Globe, accessed 10/28).

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