A surgeon sometimes moves from one operation to another before the first one is completed, leaving residents, junior surgeons, and physician assistants to complete the routine portions of a procedure – like suturing an incision – while they perform the critical parts of a case in a different operating room. This practice is known as overlapping surgery (Miller, 2019). Operating rooms are costly to run and wait times for the most skilled surgeons can be long. As such, “the pressure to be more efficient and treat more patients” can lead surgeons to schedule procedures in more than one operating room at a time (Sun & Jena, 2019). Maximizing the use of top surgeons and busy operating rooms, increasing patient access to necessary care, and providing valuable training experience for junior surgeons are a few of the practice’s advantages (Finnegan, 2019). For the most part overlapping surgery is safe, but high-risk patients are an important exception (Sun et al., 2019).
Concerns about the safety of overlapping surgery made headlines in 2015, when the Boston Globe published an investigation of the practice at Massachusetts General Hospital (Abelson et al., 2015). Their report was quickly followed by news of similar practices and safety concerns at Swedish Health, a large hospital system in Seattle (Sun & Jena, 2019). In 2016, the U.S. Senate Finance Committee held hearings on the subject and released a report urging hospitals to “prohibit the practice of allowing one surgeon to manage two operations where critical parts occur at the same time” (Senate Finance Committee Staff, 2016). Since then, more research has focused on the safety of overlapping surgery. A large study published in the Journal of the American Medical Association (JAMA) in 2019 is thought to be one of the most comprehensive analyses on the subject to date; researchers found that for adult patients undergoing common operations, overlapping surgery was not significantly associated with differences in in-hospital deaths or post-operative complications (Miller, 2019; Sun et al., 2019). However, patients deemed to be at high risk – those with a “relatively high predicted probability of complications from surgery, due to age and pre-existing medical conditions” – and patients undergoing coronary artery bypass experienced higher mortality and complication rates during overlapping procedures (Miller, 2019). Additionally, overlapping surgeries ran about 30 minutes longer on average than nonoverlapping surgeries (Sun et al., 2019).
Careful patient selection and “an individualized approach based on the patient’s risk profile and pre-existing conditions” are critical for the practice of overlapping surgery (Finnegan, 2019). “As with anything else in medicine, one size does not fit all,” said Anupam Jena, Associate Professor of Health Care Policy at Harvard Medical School, and an internal medicine physician at Massachusetts General Hospital (Miller, 2019). Additionally, many people may still view the practice with distrust or believe that it fails to meet their expectations for a surgeon’s level of involvement in their care (Sun & Jena, 2019). Health professionals must take steps to restore patient trust around this matter. It is incumbent on surgeons who perform overlapping surgery to inform their patients about scheduling practices “well ahead of the surgery,” with a description of “who will perform which parts of the operation and their qualifications”; they should also identify instances in which overlapping surgery may be unsafe and avoid the practice (Finnegan, 2019). Outside of the operating room, researchers must perform stronger observational studies and randomized studies to further evaluate the safety of overlapping surgery (Finnegan, 2017).
References
Abelson, J., Saltzman, J., & Kowalczyk, L. (2015). Clash in the name of care—A Boston Globe Spotlight Team Report. Boston Globe. http://bo.st/1MLWmPp
Finnegan, J. (2017, June 29). 3 steps to restore patient trust in overlapping surgeries. Fierce Healthcare. https://www.fiercehealthcare.com/practices/3-steps-to-restore-patient-trust-overlapping-surgeries
Finnegan, J. (2019, February 28). Overlapping surgery is safe for most patients, but use with caution in those at high risk, study finds. Fierce Healthcare. https://www.fiercehealthcare.com/practices/overlapping-surgery-safe-for-most-patients-but-use-caution-those-at-high-risk-study-finds
Kalbfell, E. L., & Schwarze, M. L. (2021). Regulation of Overlapping Surgery: Progress and Gaps. Journal of Law, Medicine & Ethics, 49(1), 74–76. https://doi.org/10.1017/jme.2021.12
Miller, J. (2019, February 26). With two major exceptions, overlapping surgeries are safe overall. Harvard Gazette. https://news.harvard.edu/gazette/story/2019/02/with-two-major-exceptions-overlapping-surgeries-are-safe-overall/
Senate Finance Committee Staff. (2016). Concurrent and Overlapping Surgeries: Additional Measures Warranted. United States Senate. https://www.finance.senate.gov/imo/media/doc/Concurrent%20Surgeries%20Report%20Final.pdf
Sun, E., & Jena, A. (2019, February 26). “Overlapping surgery” is safe for most patients, but not all. STAT. https://www.statnews.com/2019/02/26/overlapping-surgery-safe-most-patients/
Sun, E., Mello, M. M., Rishel, C. A., Vaughn, M. T., Kheterpal, S., Saager, L., Fleisher, L. A., Damrose, E. J., Kadry, B., Jena, A. B., & for the Multicenter Perioperative Outcomes Group (MPOG). (2019). Association of Overlapping Surgery With Perioperative Outcomes. JAMA, 321(8), 762–772. https://doi.org/10.1001/jama.2019.0711
