Concurrent surgery is safe for patients—sometimes

A study of neurological patients found overlapping surgery was safe under some circumstances.

Overlapping surgery is a controversial topic, but a new study has found there’s no difference in patient outcomes if a surgeon is involved in overlapping procedures.

The practice came into the public eye when the Boston Globe’s spotlight team first reported it was happening at Massachusetts General Hospital in Boston and other U.S. teaching hospitals. Last year, a U.S. Senate committee investigated the practice of concurrent surgeries, which is common practice at 47 hospitals across the country.

The committee released a report in December urging hospitals to prohibit the practice of allowing one surgeon to manage two operations where critical parts occur at the same time.

A new study, published today in JAMA Surgery, found there was no difference in mortality, morbidity or worsened functional status at discharge and follow-up when surgeons schedule operations for two patients—but only when noncritical portions of the surgeries overlap.

Researchers based at Emory University in Atlanta reviewed the cases of 2,275 patients who underwent mostly complex neurosurgery at Emory University Hospital between January 2014 and 2015.

They found no difference when they compared deaths, complications and patient functional status within 90 days for patients who underwent overlapping versus non-overlapping surgeries. They defined overlapping surgery as when a surgeon moves from a procedure in which all critical components have been completed to a second procedure, allowing colleagues to finish noncritical parts of the surgery.

Researchers concluded that surgeons can safely perform overlapping surgery, which has the potential to make sought-after specialists available to a greater number of patients. The study did find that overlapping surgeries were significantly longer than non-overlapping procedures.

Common in teaching hospitals, the researchers said overlapping surgery may be a key factor in training the next generation of surgeons through a system of supervision and progressive autonomy.

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Ultimately, the surgeon must decide which patients are candidates for overlapping procedures. "Surgeons must use their experience, keen intuition and respect for their own ability and limitations to carefully select patients" for overlapping surgery, the study said.

In an accompanying commentary, David B. Hoyt, M.D., of the American College of Surgeons, said the study was very important as there is little scientific data to settle the discussion of whether overlapping surgery is safe. He noted that researchers differentiated between overlapping surgery and concurrent surgery, where a surgeon is simultaneously involved in the critical components of two procedures on two separate patients.

New guidelines were released in 2016 by the American College of Surgeons that stress informed consent so a patient knows that a surgeon will be performing overlapping surgeries.