Concurrent surgeries are back in the news. Also called overlapping surgeries, some surgeons have the practice of operating on more than one patient in different operating rooms at the same time.
A variety of explanations have been offered for why this ever happens. Most commonly, concurrent surgeries occur at major academic teaching hospitals. Well-known surgical professors count them as an opportunity for surgeons still in clinical training (residency or fellowship) to get one-one experience.
Informed consent
Oftentimes, patients who were treated in an overlapping surgery have no complications and never know about it. Yet, many patients are understandably upset when they learned that the surgeon they selected to operate on them was largely absent from the operating room. This is a topic that is often concealed or not openly discussed during the informed consent process.
Interestingly, the American Society of Plastic Surgeons issued a policy statement on concurrent surgery. (I found it interesting because, in my opinion, this society rarely has much to say about patient safety). I think this “best practices” recommendation on informed consent is excellent:
“The surgeon should explain to the patient that he/she may exit the operation before its completion, and that qualified surgical personnel will be present at all times during the operative procedure. Hence, the patient should be informed during the consent process that the primary surgeon may not be physically present in the operating room for the entire duration of the surgery, but will be present for the critical portions of the procedure.”
Complications
Then there are other times when there is an emergency situation that arises during surgery, while the lead surgeon is absent from the operating room.
Situations like these led the U.S. Senate Finance Committee to convene hearings and even issued a staff report on the safety issues related to concurrent and overlapping surgeries. You can read the 2016 report here.
The concurrent surgery complication challenge reminds me of the situation that occurs with anesthesia care.
Most of the time, there aren’t complications when a certified registered nurse anesthetist (CRNA) is managing anesthesia in an operating room where an anesthesiologist physician isn’t present. When there’s an emergency, though, having an anesthesiologist, who has extensive critical care and airway training, may mean the difference between brain injury or death versus recovery.
Similarly, there aren't always complications during concurrent surgeries. When there are, though, it seems that the best interest of patient safety is to have the most trained surgeon physically present in an operating room.
Boston surgeon eating, sleeping in his car during surgery
A well-known surgeon at Boston Medical Center who was, the head of spine surgery at the hospital, was reprimanded by Massachusetts authorities in October 2021.
His offense? He left the operating room before emergency ankle surgery had even begun. He went to his car in the hospital parking lot, where he ate a meal and then fell asleep and never showed up for the surgery.
This happened at a major academic teaching hospital. The chief resident, who was in his last year of spine surgery clinical training, was left to perform the surgery independently without any supervision or oversight by the lead surgeon.
According to the state medical board, the lead surgeon, who is responsible as the attending surgeon for orthopedic trauma emergencies at the hospital, escorted the patient with the chief resident into the operating room, before leaving.
The surgeon’s conduct violated hospital policies, which require attending surgeons to be present for the critical parts of surgeries. Yet, just a year prior to this incident, the Boston Globe had reported about the same surgeon double-booking two operations at once without informing the patient. At the time, the hospital admitted that it was aware of the practice. After the new incident, though, the hospital updated its policies to prohibit concurrent operations by any surgeons on its medical staff.
If you’ve been seriously injured by operating room care in Texas, the contact a top-rated experienced Texas medical malpractice lawyer for a free consultation about your potential case.
