Experts Discuss Surgical Timing, Technique

Approximately 40% of the respondents said they perform multiple-room surgeries themselves. Among those who don’t, the most commonly cited reason was that they didn’t feel comfortable doing so. Among those who do perform such surgeries, 40% said they do so weekly. Furthermore, half of those who said they engaged in the practice also stated that they didn’t routinely inform patients ahead of time.

More than 70% of respondents said that more procedures would be delayed if multiple-room surgeries weren’t allowed. Approximately 30% said that patient safety would be improved if such surgeries weren’t allowed, and 10% said they would be detrimental to patient safety. More than 60% of respondents said residency training would suffer if the practice was not allowed.

The survey also found that a surgeon who performs multiple-room surgeries is more likely to think patient safety would be worsened and that wait times would lengthen if the practice were disallowed.

Respondents could also make remarks on the practice of overlapping surgeries. “I can tell you, reading through the comments, there are many varied opinions and many of them are very passionate,” Dr. Cognetti said.

One respondent said that patient safety isn’t compromised, that residents are allowed more operating time, and that “expert surgical care is maintained by the responsible surgeon.” Another said, “No one can be two places at once. Accept it. The patient believes you are their physician and you are caring for that person—but you are not.”

Effectiveness in Overlapping Surgeries

In a study conducted at the University of Alabama at Birmingham (UAB) and Oregon Health and Science University, researchers looking at microvascular free tissue transfer procedures for reconstruction of head and neck defects found no statistical difference in several areas between non-overlapping and overlapping procedures. Overlapping procedures were defined as those in which they both had a first start or the second operation began before the first was finished, with the attending surgeon not performing the critical components concurrently.

In the study, which involved 1,315 surgeries, there was no difference in complication rate, in length of stay, or in free-flap survival rate. There was a significant difference in the amount of anesthesia time, with patients involved in overlapping procedures receiving an average of 21 more minutes of anesthesia.

“We found that overlapping operations can be performed [as] effectively and with equivalent quality as those that were non overlapping,” said Larissa Sweeney, MD, a resident at UAB who presented the findings. “We advocate the continued practice of surgeons conducting overlapping operations.”

Overlapping surgeries stand at the crossroads of ethics and informed consent, patient safety, surgical education, effectiveness of care, efficiency of care, and timeliness of care.— Brian Nussenbaum, MD

Ethical Considerations

Alexander Langerman, MD, a head and neck surgeon and clinical medical ethicist at Vanderbilt University in Nashville who is researching the practice, said that while medicine has always involved delegation, the difference here is that the patient is unable to actively participate in his or her own care during surgery.