Study: Overlapping Surgeries Are Riskier After All

Latest study is first to find heightened rate of complications among double-booked operations.

In the two years since The Boston Globe’s Spotlight team published its investigation into patient safety concerns arising from concurrent surgeries at Massachusetts General Hospital, researchers have published numerous studies that show no increase in harm to patients when operations overlap.

This month, however, JAMA Internal Medicine published a study online that seems to support the Globe’s line of questioning, which prompted government inquiries and a review by the American College of Surgeons, not to mention heightened public awareness of the practice.

The new study found that complication rates were higher among overlapping hip surgeries than operations done one at a time and that longer durations of overlap were associated with increased risk.

“Currently, this seems to be the first study to show an adverse effect from the practice of overlapping surgery,” Alan Zhang, MD, an orthopedic surgeon at the University of California San Francisco, wrote in commentary released with the findings. “Prior studies, including those performed at my institution, have found no association between patient complications and overlapping surgery.”

One thing that differentiates this latest study from earlier reports on the topic is its size, as MinnPost’s Susan Perry noted. The study reviewed records from more than 90,000 hip replacements across some 75 hospitals and tracked patients for a full year after surgery.

“The size, the numbers, the multiple institutions, and the long-term follow-up dwarf any of those other studies,” James Rickert, MD, an orthopedic surgeon and president of the Society for Patient Centered orthopedics, told the Globe.

Medicare billing rules permit overlapping surgeries, as long as the attending surgeon is there for the critical moments, so it’s up to hospitals to decide whether they will allow the practice, as Kaiser Health News reported earlier this year.

“In the name of efficiency, it makes a lot of sense for the surgeon to get to the closing, turn it over to one of the residents or fellows and go to the next room where the opening has already occurred for the next surgery,” Spotlight editor Scott Allen told HealthLeaders Media last year.

“It is easy to understand how that sort of staggering makes sense from an efficiency standpoint and doesn’t jeopardize the patient’s well-being in any way,” he added. “You have people working at their appropriate level of responsibility from start to finish.”

There are two general circumstances in which it could be appropriate for one surgeon to oversee two operations simultaneously, according to ACS guidelines released last year: either (1) when the key elements of one surgery have been completed and the surgeon is no longer needed or (2) when the key elements of one surgery have been completed and the primary surgeon has assigned immediate availability to another surgeon for the procedure.

“The patient needs to be informed in either of these circumstances,” the ACS guidelines state. “The performance of overlapping procedures should not negatively affect the seamless and timely flow of either procedure.”