Overlapping Surgeries: Understanding the Real Risks and Benefits for Patients
"A closer look at the data reveals surprising insights into overlapping surgeries and patient outcomes, challenging common misconceptions."
The debate surrounding overlapping surgeries—where a surgeon manages two operations concurrently—has stirred considerable concern among patients and healthcare professionals. A common worry is that this practice compromises patient safety and the quality of care. However, recent research offers a different perspective, suggesting that the reality might be more nuanced than initial fears indicate.
A study published in Neurosurgery (Bohl et al., 2018) specifically investigated the outcomes of 14,872 neurosurgical cases performed at a single institution. The research aimed to determine if overlapping surgeries were associated with worse patient outcomes. This large-scale retrospective analysis provides valuable data that challenges some of the prevailing negative perceptions.
This article aims to dissect these findings, offering a clear, accessible overview of what the science really says about overlapping surgeries. We'll explore the potential benefits and risks, and help you understand what this means for you or your loved ones facing surgery.
Safe for Most, Risky for Some
A large analysis found that overlapping surgery is generally safe, except for high-risk patients and those undergoing coronary artery bypass grafting. In the ambulatory orthopaedic setting, overlapping surgery yields equivalent operating room time, procedure time, and 30-day complication rates compared with non-overlapping surgery. The practice improves efficiency because the surgeon alternates between two rooms to minimize downtime associated with room clean-up and set-up, making more efficient use of the surgeon's time. Critics caution, however, that existing data are limited, with one review noting that more than half of procedures were excluded for missing data and that the surgeries represented the work of just over 200 surgeons, warranting a "grain of salt."
Parallel Lists and the Moving Surgeon
Overlapping surgery, more pejoratively called double-booking, is organized by running surgical lists in parallel with a single senior surgeon moving from one operating theatre to the other. It is typically used to increase efficiency for both surgeons and anesthesiologists, and a possible benefit for patients is decreased wait times for procedures. However, the approach has well-documented limitations and dangers, as junior surgeons start non-critical portions of operations while the senior surgeon is occupied elsewhere. Proponents argue that an evidence-based approach to policy is crucial not only to maximize patient safety but also to make highly specialized surgical care available to as many patients as possible.
From Widespread Practice to Scrutiny
Overlapping surgery has long been used at both teaching and non-teaching institutions, though concerns about potential adverse outcomes have grown over time. A notable Harvard analysis showed the practice carries no greater risk for low-risk, noncardiac patients, marking a key milestone in the debate. Meanwhile, a strongly worded editorial argued that concurrent surgery, in which important parts of two patients' procedures take place at the same time, should become part of surgical history because it violates a fundamental commitment a surgeon makes when agreeing to care for a patient. Regulatory attention has also escalated, with teaching institutions facing unique risks under Medicare payment requirements and enforcement, including False Claims Act cases, on the rise.
Debunking Myths: What the Data Reveals About Overlapping Surgeries
The Neurosurgery study (Bohl et al., 2018) found that overlapping surgeries were not associated with worse patient outcomes. This conclusion challenges the assumption that dividing a surgeon's attention leads to compromised care. The researchers conducted a retrospective multivariate analysis, a robust statistical method that accounts for multiple variables, ensuring a comprehensive assessment of the data.
- No increase in complication rates
- No significant difference in readmission rates
- No higher mortality observed
- Efficient use of surgical resources
Neurosurgery and Orthopaedics Under the Microscope
Recent systematic reviews and meta-analyses have focused on specialties where overlapping surgery is common but has recently come under scrutiny, particularly neurosurgery. Reviews pooling data from PubMed and Medline on overlapping neurosurgical procedures have examined patient demographics, procedure type, outcomes, and complications to assess whether the practice affects results. In orthopaedics, a review found that although overlapping surgeries tended to have increased surgical times, short-term outcomes were no different than non-overlapping surgeries; however, one study showed an increased risk of adverse events at one year. This mixed picture underscores the need for continued, higher-quality outcome data before drawing firm conclusions.
Settlements, Headlines, and Reassuring Data
Countervailing evidence suggests overlapping surgery is not significantly associated with differences in rates of in-hospital mortality or postoperative complications in adults undergoing common surgeries, according to a study published in JAMA. Yet high-profile incidents, such as a settlement involving Baylor, have kept concerns alive, with experts emphasizing that surgeons treating more patients through this practice must adhere to certain guidelines. Critics also point to how the arrangement works in practice: non-critical portions of operations are started by junior surgeons in a parallel theatre while the senior surgeon completes the critical parts on the first patient before joining the second. These competing findings and high-profile failures explain why the practice remains contested despite broadly reassuring data.
Concurrent Versus Overlapping Outcomes
Comparative work distinguishes between concurrent surgery, in which the critical portions of two procedures genuinely overlap, and overlapping surgery, in which the lead surgeon completes the key parts of one operation before starting the next. In one major analysis, overlapping surgeries ran notably longer — 204 minutes compared with 173 minutes for non-overlapping procedures — which let researchers isolate differences in outcomes for individual surgeons performing one surgery at a time versus overlapping surgeries. Research on overlapping total joint arthroplasty reports satisfactory short-term revision rates, though the authors caution that prolonged follow-up is required to assess medium-term and long-term outcomes. These comparisons highlight that the safety question depends heavily on case mix, surgeon, and how carefully the overlap is managed.
Making Informed Decisions About Your Surgical Care
Understanding the facts about overlapping surgeries empowers you to make informed decisions about your healthcare. While the idea of a surgeon managing multiple cases simultaneously may seem unsettling, the evidence suggests that it doesn't necessarily compromise patient safety. By engaging in open communication with your healthcare provider, you can address any concerns and gain a clearer understanding of the protocols and safeguards in place to ensure your well-being throughout the surgical process.
A Precise Definition at the Core
Expert commentary converges on a precise definition of the practice: "overlapping" surgeries are those in which the primary surgeon starts a new operation after finishing the critical parts of another surgery, but before that first surgery is completely finished. This framing matters because it distinguishes overlapping surgery from true concurrent surgery, where critical portions genuinely run at the same time. The distinction shapes both patient expectations and institutional policy, since the level of risk and the obligations to disclose differ depending on which form is being used.
Nursing's Role in the Next Phase
Looking ahead, patient safety organizations are turning attention to how overlapping and concurrent surgeries are handled at the bedside, particularly the role of perioperative nurses. A key concern is that some surgeons may lead overlapping or concurrent surgeries with the potential to leave one patient waiting while under anesthesia as the first patient is finished. Nursing organizations are promoting structured patient safety actions to address these gaps, signaling that the future of overlapping surgery will hinge as much on perioperative vigilance and communication as on surgeon scheduling practices.
Efficiency, Waiting Lists, and Compliance Pressures
Overlapping surgery has been used for many years by hospitals and surgical centers, and it generally refers to situations where one lead attending surgeon is responsible for multiple surgical procedures that overlap in time. Although safety concerns have been raised, recent studies — including a retrospective cohort study of over 87,000 surgical patients — have not found significant differences in perioperative outcomes. The practice has also been discussed as a potential route to reducing hospital waiting lists, yet one analysis finds no evidence that overlapping surgery actually reduces them. At the same time, the compliance landscape is tightening, as healthcare providers face growing regulatory scrutiny over how overlapping lists are run and documented.
What the Trade-Offs Mean for Patients
For patients, the stakes of the overlapping surgery debate are deeply personal: without the practice, surgeons may be forced to cancel an elective case for a patient who has waited months, or operate late into the night, risking complications from fatigue. National reporting on a study of more than 60,000 operations found the practice is safe for most patients, though there may be a small added risk for a subset of high-risk individuals. Separately, an analysis concluded that overlapping surgeries carry no greater risk for low-risk, noncardiac patients. These findings frame the real-world impact as a balancing act between access and vigilance for the most vulnerable patients.