Overlapping surgery (also known as double-booking or concurrent surgery) is a common, but little-known, practice in which a single surgeon supervises two (or more!) operations, in different operating rooms, at the same time.
That doesn’t sound like a prescription for great patient outcomes. And indeed, a new study casts doubts on the safety of this practice.
The researchers, whose work was published in JAMA Internal Medicine this week, covered over 90,000 hip fracture surgeries over a five-year period in Ontario, Canada. They found that for patients undergoing overlapped procedures, there was an approximately 90% increase in the risk for complications at one year. Moreover, the longer the duration of overlap between surgeries, the more likely patients were to suffer a serious complication within a year. Complications included infections, dislocations, and a need for follow-up surgery.
This study is especially noteworthy in that it is the first to show that overlapping surgery can pose health risks. Unlike previous studies, the Canadian study was large in scope—comparing operations at more than 75 hospitals, involving thousands of patients. The study also looked at outcomes up to a year after the surgeries, giving a fuller picture of patient recovery.
From a common sense perspective, the results seem quite obvious. As Dr. Bheeshma Ravi, lead author of the study, commented to the Boston Globe, “If your surgeon is in multiple places, there’s an increased risk of having a complication. I think that just makes sense.”
Hospitals don’t often tell patients their surgeon has been double-booked
Double-booking poses a problem regarding informed consent. Most hospitals do not require surgeons to tell patients when they will be caring for a second patient at the same time. Many patients never find out that their surgeon had been working in simultaneous surgeries.
Double-booking has become a divisive issue at hospitals across the nation, and locally, particularly at MGH. A Boston Globe spotlight in 2015 reported that MGH’s orthopedic surgeons sometimes scheduled two operations that overlapped for hours, and doctors alleged that patients were endangered and had not consented to share their surgeon. MGH subsequently imposed new limits on overlapping surgeries, but took the position that no patients were imperiled by the practice.
“First, do no harm.”
Hospitals advocate concurrent surgeries in the name of efficiency—it allows more patients to see popular doctors, and it cuts down on “wasted” operating room time. But efficiency and profit must never be put before patient well-being.
In light of this study and other studies that are sure to follow, hopefully hospitals will realize the need to change their practices in their commitment to patient safety.
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