MEDICAL RESEARCH

Few people know about overlapping surgery

Most people aren't aware that surgeons are sometimes involved in multiple operations happening at the same time, and many patients might object to the practice if they knew about it, a recent U.S. study suggests.

Researchers focused on what's known as overlapping surgery, when a senior surgeon performs critical components of one operation at the same that a trainee surgeon or physician assistant handles a non-critical portion of another procedure. For example, it might mean the assistant closes up an incision on one patient while a senior surgeon begins an operation on another patient.

Only about 4 percent of the 1,454 people surveyed for the study had heard of overlapping surgery, the study found. Just 31 percent of them strongly supported the practice once it was explained, and nearly all of the participants thought patients should be told before surgery exactly what aspects of their operations might be handled by a senior surgeon or by a trainee, or resident, surgeon or an assistant.

"Surgeons should discuss overlapping surgery with patients beforehand and obtain their consent if this is part of their practice," said lead study author Dr. Michael Kent of Beth Israel Deaconess Medical Center and Harvard Medical School in Boston.

Generally, people understand the pros and cons of the practice once they know what it is, Kent added by email.

"Respondents understood that overlapping surgery allows surgeons to potentially perform more operations in a given day, so patients may not need to wait as long for their procedure," Kent said. "They also understand that complications may occur when a surgeon's attention is divided, and this may have an impact on patient safety."

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For the study, Kent and colleagues surveyed participants about their knowledge of overlapping surgery, their expectations regarding disclosure during the informed consent process and their willingness to have this type of surgery as a patient.

Half of the participants were at least 33 years old, and they ranged in age from 21 to 74.

During the survey, researchers randomly selected one of three scenarios to illustrate what happens during overlapping surgery: a hip replacement, a procedure to remove a brain tumor or a heart valve replacement. All three scenarios offered similar descriptions of the roles filled by senior surgeons and assistants.

Overall, about 92 percent of respondents thought surgeons should document what portion of the operations they were present for, researchers report in the Journal of the American College of Surgeons.

When asked specifically about assistants or trainees, 86 percent of participants thought patients should be told prior to surgery who would be in the operating room and 84 percent thought the precise role of trainees should be disclosed.

After overlapping surgery was described, about 70 percent of participants thought the practice might be acceptable in certain circumstances, such as lower-risk procedures or in situations when an emergency occurred in another operating room.

The survey was done using Amazon Mechanical Turk, an online crowd-sourcing worksite, and it's possible the participants' responses might not reflect a broad cross section of the general public, the authors note.

Also, the study focused on the more accepted practice of overlapping surgery, not situations, known as concurrent surgery, when one senior surgeon is in charge of crucial portions of two different operations at the same time.

Concurrent surgery, is rare and generally should be avoided unless there's an urgent or unplanned situation, said Dr. Karl Bilimoria, director of the Surgical Outcomes and Quality Improvement Center at Northwestern University's Feinberg School of Medicine in Chicago.

Overlapping surgeries, like the kind examined in the study, are more common and relatively safe, Bilimoria, who wasn't involved in the study, added by email.

"The resident or physician assistant given this responsibility is well trained and competent to take on that task without the surgeon physically present," Bilimoria added. "In many cases, the resident or physician assistant has done this hundreds or thousands of times."