Understanding the difference: Concurrent vs. Overlapping Surgery
To address the question of whether a surgeon can perform two surgeries simultaneously, it is crucial to differentiate between two practices: concurrent surgery and overlapping surgery. These terms are often used interchangeably by the public but have distinct meanings in the medical community.
Overlapping surgery explained
Overlapping surgery involves a single attending surgeon managing parts of two surgical procedures in different operating rooms, but only when non-critical parts of each operation are taking place. For example, a surgeon might be with one patient during a delicate, critical portion of a procedure, while a resident or a qualified associate performs a more routine, non-critical task, such as closing an incision, in another room. Once the critical part is complete in the first room, the surgeon can move to the next. This practice is considered more ethically sound and is an established method for optimizing operating room efficiency and training junior surgeons.
Concurrent surgery defined
In contrast, concurrent surgery occurs when the critical or key portions of two operations are performed at the same time. This means the primary attending surgeon is unable to be physically present for the critical moments of both procedures. This practice is highly controversial and widely considered to be unethical and medically inappropriate by most surgical societies and institutions. The split attention of the lead surgeon during the most difficult parts of an operation raises significant concerns about patient safety, delayed responses to complications, and overall quality of care.
Ethical and safety considerations for patients
The practice of surgeons overseeing multiple procedures raises a number of ethical and safety issues. While efficiency and reduced wait times are often cited as motivations for overlapping surgeries, patient welfare is paramount.
Informed consent
One of the most critical aspects is informed consent. Patients have a right to know who will be performing their surgery and when their surgeon will be present. Hospitals and surgical teams are ethically obligated to disclose their scheduling practices to patients. However, transparency can sometimes be lacking, leaving patients unaware of the potential for overlapping procedures. This can lead to a violation of patient trust and an ethical breach if the patient's consent was not truly informed.
Patient safety risks
Despite some studies suggesting that overlapping surgeries may not increase complication rates for most patients, some research has indicated potential risks, particularly for high-risk patients or specific types of complex procedures. Complications, such as stroke or heart attack, have been found to be slightly higher in some overlapping cases. An attending surgeon's divided attention can also lead to delays in addressing complications, which could have serious consequences. The definition of what constitutes a “critical or key” portion of a surgery is often left to the surgeon's discretion, which introduces a subjective element into a process that demands the utmost objectivity.
The role of surgical teams
While the attending surgeon is the lead, a surgical team is composed of many skilled professionals, including residents, fellows, and nurses. In overlapping surgery, residents and fellows often perform non-critical steps under the guidance of the attending surgeon. This is a crucial part of their training. However, concurrent surgery, where critical steps are delegated, blurs the line between training and potentially dangerous delegation. The experience and skill of the non-attending staff are a factor, but a less experienced surgeon handling a critical stage of a procedure without the full attention of the lead surgeon is a significant risk factor.
How hospital policies and regulations address surgical scheduling
Hospitals and regulatory bodies have attempted to address the complexities of surgical scheduling with various policies. These policies often distinguish clearly between acceptable overlapping procedures and unacceptable concurrent procedures.
Regulations and billing rules
Government health programs, such as Medicare, have specific rules regarding billing for teaching surgeons and their presence during key portions of operations. These rules are designed to ensure patient safety and proper oversight, though some critics argue they are not stringent enough. Professional surgical associations have also issued position statements, generally condemning concurrent surgery and providing guidelines for acceptable overlapping surgery.
Hospital policies
Within hospitals, policies vary widely. While some institutions strictly regulate or even prohibit concurrent surgery, others have been known to allow it in the name of efficiency. Some hospitals have been the focus of public scrutiny and investigative reports for practices that prioritize revenue over patient safety. A strong, transparent hospital policy that prioritizes patient consent and surgeon presence during all critical steps is essential.
How overlapping surgery differs from team-based surgery
It's important not to confuse overlapping surgery with team-based surgery. Team-based surgery, which is standard practice, involves a group of surgeons and support staff working together on a single patient. Each member has a specific role, and the lead surgeon remains present and focused on the procedure. This is fundamentally different from a single surgeon attempting to manage two separate operations in different rooms, regardless of the stage.
Comparison of overlapping vs. concurrent surgery
| Feature | Overlapping Surgery | Concurrent Surgery |
|---|---|---|
| Attending Surgeon's Presence | Present for all critical portions; may be absent for non-critical phases. | Absent during critical portions of at least one procedure. |
| Critical Parts Overlap | No. Critical parts of each surgery are intentionally staggered. | Yes. Critical parts of two surgeries happen at the same time. |
| Ethical Standing | Generally considered acceptable within professional guidelines. | Widely condemned as unethical and unsafe by professional surgical bodies. |
| Motivation | Maximize operating room efficiency and allow for resident training. | Often cited for efficiency, but primary motivation can sometimes be financial. |
| Transparency to Patient | Should be disclosed as part of informed consent. | Requires explicit disclosure, but often is not. |
| Patient Safety Concern | Lower risk for most patients, though higher-risk cases warrant caution. | Higher risk of complications due to split surgeon attention. |
The patient's role: Being an advocate for your own care
Given the complexities and potential risks, patients have a right to be informed and to advocate for their own safety. Asking the right questions before a procedure is crucial.
- Directly ask your surgeon: In your pre-operative consultation, ask your surgeon directly if they will be performing any other procedures at the same time as yours. Use the terminology "overlapping" and "concurrent" to ensure clarity.
- Clarify the team: Ask who will be assisting in the operating room. Inquire about the role and experience level of any residents or fellows involved.
- Request a clear statement: Ask your surgeon to define what they consider the "critical portions" of your surgery and to confirm they will be physically present for all of them.
- Confirm hospital policy: You can also contact the hospital's patient relations department to understand the hospital's official policy on overlapping surgery.
Conclusion
While a surgeon cannot ethically or practically be in two places at once during critical portions of an operation, overlapping surgeries—where only non-critical phases overlap—is a common practice designed to enhance efficiency. The more dangerous practice of concurrent surgery, where critical phases overlap, is widely condemned. Patients must be proactive and fully informed to ensure their surgeons adhere to the highest standards of safety and ethical conduct. By understanding the terminology and asking the right questions, patients can advocate for the attention they deserve and ensure a safer surgical experience. For more information on patient rights and surgical safety standards, visit the American College of Surgeons website.
