Mayo Clinic: Overlapping surgeries are safe (at least at our hospitals)

Practice of overlapping surgeries has come under scrutiny after investigation

Overlapping surgeries at Mayo Clinic facilities have the same patient outcomes as non-overlapping surgeries, according to a Mayo study published in Annals of Surgery.

Background

Overlapping surgeries—in which an attending surgeon is responsible for multiple surgeries in multiple ORs at the same time for at least a portion of the procedures—are a fairly common practice and are permitted at many teaching hospitals.

But the practice of overlapping surgeries has come under scrutiny after a Boston Globe investigation found that some surgeons have raised patient consent and safety concerns about hospitals' practices.

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.

Meanwhile, proponents of overlapping surgeries 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.

Mayo Clinic study

The Mayo Clinic researchers looked only at overlapping surgeries, in which operations are staggered so the key portions do not happen at the same time. They did not investigate concurrent surgeries, in which an attending surgeon is responsible for multiple surgeries in multiple ORs at the same time and the critical portions overlap. Mayo noted that such surgeries are rare and are banned by Medicare.

Mayo researchers analyzed about 10,000 overlapping surgeries and about 16,000 non-overlapping surgeries on patients at Mayo campuses. In addition, researchers also looked at more than 10,000 operations at Mayo Clinic's Rochester campus, about 3,000 of which were performed concurrently.

The analysis found no difference in post-op complications, outcomes, or mortality rates within a month after surgery between patients who underwent overlapping surgeries and patients who did not.

The researchers noted that the findings are based off of Mayo data and only apply to their institution, which has strict rules surrounding overlapping procedures.

Co-author Robert Cima said, "Our data shows that overlapping surgery as practiced here is safe." He added, "We think it provides value to our patients because it allows more patients timely access to surgery and care by expert teams" (Ross, "On Call," STAT News, 12/1; KTTC/WXOW, 12/1; Mayo Clinic release, 12/1).

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