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SURGICAL SUITE: What is concurrent surgery? Is it a good idea?

Concurrent surgery means that a surgeon is double-booked – running two operations in different operating rooms at the same time – sometimes also referred to as overlapping cases or simultaneous surgery.  In teaching hospitals, this is likely to involve having surgical residents perform part of the procedures.  In this blog post, I will mention some of the recent literature on concurrent surgery.

(1)  In this Boston Globe story, a 2012 case involving a leading Massachusetts General Hospital neurosurgeon and a patient who was discovered to be paralyzed after the procedure during which the surgeon was double-booked is reported.  Source: Abelson, J., Saltzman, J., Kowalczyk, L., and others. (2015, Oct. 25). Clash in the name of care. Boston Globe.  Click here for full text: https://apps.bostonglobe.com/spotlight/clash-in-the-name-of-care/story/

(2) Surgeons from Duke present the advantages associated with concurrent surgery in the academic medical center setting and advocate its continuation under existing Medicare policy guidelines.  Source: Beasley, G.M., Pappas, T.N., and Kirk, A.D. (2015, June). Procedure delegation by attending surgeons performing concurrent operations in academic medical centers: Balancing safety and efficiency. Annals of Surgery. 261(6), 1044-1045. Click here for full text: http://journals.lww.com/annalsofsurgery/Citation/2015/06000/Procedure_Delegation_by_Attending_Surgeons.5.aspx

(3) Efficiency and patient outcomes for cardiothoracic patients were studied over a 2-year period (2011 to 2013) at the University of Virginia Charlottesville.  Record review found no negative effect on patient outcomes and no problem as far as lengthening overall operative duration associated with concurrent surgery.  There was a small impact on later starting and closing times.  Source: Yount, K.W., Gillen, J.R., Kron, I.L., and others. (2014).  Attendings’ performing simultaneous operations in academic cardiothoracic surgery does not increase operative duration or negatively affect patient outcomes.      Click here for abstract: http://aats.org/annualmeeting/Program-Books/2014/2.cgi

(4) Here are the Medicare requirements for when a teaching surgeon may bill for two overlapping procedures.  Source: U.S. Department of Health & Human Services, Centers for Medicare & Medicaid Services. (2011, Sept. 14). CMS manual system: Pub 100-04 Medicare claims processing.  Transmittal 2303. Click here for full text: https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R2303CP.pdf

(5) An opinion just out in JAMA discusses the concerns of the public on this issue and advocates self-regulation by surgeons and transparency in communication about this with patients.  Source: Mello, M.M., and Livingston, E.H. (2016, Mar. 17). Managing the risks of concurrent surgeries. JAMA. Click here for full text: http://jama.jamanetwork.com/article.aspx?articleID=2505160&utm_source=Silverchair_Information_Systems&utm_campaign=Thursday_March_17_2016&utm_content=olf&cmp=1&utm_medium=email   Posted by AHA Resource Center (312) 422-2050, rc@aha.org

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