What Does it Mean for a Surgeon to “Run Two Rooms”? A Comprehensive Literature Review of Overlapping and Concurrent Surgery Policies

Abstract

The aim of this study was to review and analyze all of the “concurrent surgery” (CS) and “overlapping surgery” (OS) literature with the goal of: standardizing terminology, defining discrepancies in the literature and proposing solutions for the current challenges of regulating surgery to achieve maximal safety and efficiency. The CS and OS literature has grown exponentially over the past two years. Before this, there were no significant publications addressing this topic. There is an extremely wide variance on how “running two rooms” is defined and whether it should be permitted. These differences affect our patients’ perception of this practice. The literature lacks any comprehensive review of the topic and terminology. We performed a PubMed search to identify studies that considered the issue of OS. The terms “overlapping surgery”, “concurrent surgery”, and “simultaneous surgery” (SS) were used in the query. We then analyzed the publications identified. The literature contained 18 published studies analyzing OS safety between November 2016 and June 2018. Eight were neurosurgical studies, three were orthopedic, and the remaining seven articles were in other surgical specialties. A total of 1,207,155 surgical cases (range 250–>500,000 patients) were analyzed among the 18 studies. There were 57,880 (5.04%) OS cases. The OS rates in the individual studies ranged from 1.2 to 68 per cent (Table 1). Neurosurgical studies had the highest average OS rate of 54 per cent (range 37–68%), whereas the average OS rate in orthopedic surgery was 43 per cent (range 2.7–68%). Approximately one-third of the studies were multicenter investigations (27.7%). The studies measured more than 20 distinct outcomes, but there were only five outcomes that were included in the majority of the studies: mortality rates, reoperation rates, procedure length of time, readmission rates, and hospital length of stay. The current body of literature repeatedly demonstrates that OS is a safe and effective option when undertaken by experienced surgeons who practice it frequently. For successful OS, the Mandatory Attending Portion for two surgeries must not overlap and Unnecessary Anesthesia Time must be prohibited. Hospitals and surgical specialty organizations must implement policies to assure the safe practice of OS.

The effect of overlapping surgical scheduling on operating theatre productivity: a narrative review

“…readmission rates; and duration of stay. None of these significantly differed between overlapping and traditional models [38]. However, cases were grouped by retrospectively judging as to whether the patient had overlapped another.…”

“…Thus, only two of 18 studies reviewed by Theriault et al. analysed anaesthesia times [38]. When the correct metric of total operation time (i.e.…”

Impact of Overlapping Neuro-Surgeries on Patient Care Quality

“…Critical portion is described as the "stages when the essential technical expertise and surgical judgement are necessary to achieve optimal patient outcome." However, most of the time the surgeon only documents "I was present for the critical portion of the case, but not what the critical part of that case was" [2].…”

“…Reference [2] noted "OS" has been a common surgical practice for over 75 years, particularly in the surgical specialties in which the noncritical parts of opening and closing can routinely last for hours. OS primarily occurs in academic and Level I trauma centers, because they often have highly skilled surgical fellows and residents to assist with long opening and closures.…”

Perceptions and Awareness of Overlapping Surgery in Patients With Shoulder Pain Presenting to an Orthopaedic Sports Medicine Clinic

“…Overlapping surgery is a common practice in high-volume settings such as academic medical centers. 1 While this has been common practice for some time, public recognition has increased with landmark publications such as the 2015 Boston Globe article. The story described the process of overlapping surgery at the Massachusetts General Hospital and raised concerns over patient safety and outcomes.…”