The increasing prevalence of overlapping surgery

Bradley T. Truax, MD, principal consultant of the Truax Group, is board-certified in both neurology and internal medicine and has been involved in patient safety for more than 25 years. He says there are no clear estimates on the prevalence of overlapping surgeries (OS). What is clear, though, is the wide variation in OS rates by hospital and by department. Some hospitals have reported OS rates over 70% in some departments, especially in orthopedics, neurosurgery, and otolaryngology.

The first thing that hospitals need to get straight, Truax says, is the terminology. Often people incorrectly use the phrases “overlapping surgery” and “concurrent surgery” interchangeably.

“No one condones concurrent surgery (where critical parts may overlap),” he says. “Overlapping surgery is where a surgeon is present for the entire ‘critical portion’ of the surgery and then moves to another case and lets a resident, fellow, or surgical assistant finish the first case.”

The term “critical portion” is a major stumbling block in the OS debate. Since there are no unified parameters on what parts of a surgery are “critical,” it’s up to hospitals to decide.

Truax is adamant that when crafting an OS policy, individual surgeons shouldn’t be allowed to determine what the critical parts are. Instead, this definition should be crafted by specialty societies or by the chair of the clinical department.

“There must be a single definition for all specific procedures,” he says. “[For example,] a total knee replacement would have the same definition regardless of who is doing the surgery. Mello and Livingston in their perspective on overlapping surgery even note that the clinical department has an innate conflict of interest and call upon hospitals to have multidisciplinary committees that establish the ‘critical part’ for each procedure.”

Source: News & Analysis