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Overlapping Surgical Procedures May not be Best Bet for High Risk Patients

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The practice of scheduling surgeries to overlap could place some patients in danger.

Many patients may not be aware that they share their surgical team with other patients undergoing similar or complimentary procedures.  Overlapping surgery is a scheduling method designed to optimize the time members of a surgical team spend performing their surgical responsibilities.

When a surgical specialist completes their portion of a procedure, they transfer to a different operating setting where another patient is awaiting the specialist.  Other surgeons, junior surgical team members, or residents may close after the senior surgeon is finished.

In the last several years, the method has gained prominence in teaching and other busy hospitals, but is not without controversy. A widely circulated piece by the Boston Globe took aim at the practice, citing a Canadian study that found patients who underwent overlapping hip surgeries had a 90 percent increase in risk for infection, serious surgical complication,  or follow-up surgery within one year following the initial surgery.

The lead author of the study, Dr. Bheeshma Ravi noted,  “If your surgeon is in multiple places, there’s an increased risk of having a complication. I think that just makes sense.”

For some institutions, like Massachusetts General Hospital, best practices include maintaining a lower overlapping surgery schedule to reduce risk of surgical error and complications.  More recently, a study published in JAMA Network finds that overlapping operations are generally safe—except when they are not.

The study, a collaboration of Harvard Medical School and Stanford University looked at surgical results from 66,430 patients who had undergone spinal, knee, hip, brain, and cardiac surgeries.  Overall, the study found that overlapping surgeries did not increase mortality or complications immediately after the surgery, with two exceptions.  Those exceptions are:

  • High risk patients, such as those who were elderly, or suffered chronic conditions, experienced more complications and higher mortality rates immediately following overlapping cardiac bypass surgeries.
  • Overlapping surgeries took approximately one-half hour longer than non-overlapping surgeries, a feature which may have an impact on some patients.

Importantly, the study did not evaluate longer term consequences as was done in the earlier Canadian study.  Lead author Dr. Eric Sun with Stanford University notes, “While the overall findings of the study suggest that overlapping surgeries appear to be safe, we found evidence that this may not be true for all patients and all procedures.

For a number of reasons, surgery of any kind should be carefully considered and discussed with your physician.  Ask about complications. Ask if you are slated for an overlapping surgery schedule and be sure to speak with your surgeon about whether it is the right option for you.

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