The way surgeons have been allowed to treat patients and train future surgeons is in jeopardy. The United States Senate Finance Committee is looking to explicitly ban senior supervising surgeons from managingmore than one operating room at the same time. To outlaw this would disrupt medical training and disproportionately impact disadvantaged members of society. Following an article from the Boston Globe Spotlight Team,the practice of a single lead surgeon being responsible for two cases at the same time, so-called simultaneous surgery, has come under national scrutiny after tales of operative complications have fueled emotional outrage. The thought is that surgeons shouldn’t have to divide their attention between two patients. The problem is that fact has not matched emotion. New data from a leading neurosurgical journal has found no change in the complication rate between over 1,000 patients undergoing simultaneous or standard surgery. When properly communicated to patients, this practice is not only safe but economically efficient, medically necessary, and morally justified. To outlaw this would disrupt medical training and disproportionately impact disadvantaged members of society. Let’s allow doctors to treat patients. First and foremost, the term simultaneous surgery is in itself misrepresentative and misleading. It implies that two surgeries are started at the exact same time by the same surgeon. This is rarely the case. The proper term of use is overlapping surgery. Portions of time for one surgery overlap with the start time for another surgery. For example, a complex craniotomy (opening of the skull) for clipping of a brain aneurysm (to stop or prevent brain bleeding) may have the patient in the operating room for five to six hours for only 45 minutes of technical terror. Surgery is a team sport. Neurosurgery, for example, is not just surgery. The anesthesia team has to put the patient to sleep. This includes not only intubation but also the different lines and catheters that go into the arteries, veins and urinary system. The patient has to be positioned on the operative table. He or she may need a small procedure to drain some spinal fluid. He or she may need a special intraoperative tracking device to map out the surgical trajectory. This in itself can take over an hour. Should we delay other procedures, hold available operating rooms vacate, and cancel all other cases during this time? That would not be economically efficient nor patient centered. And, it is in this extra time that we see the most case overlap. Investigation into data from the Massachusetts General Hospital noted this exact phenomena. Across 37,000 surgical procedures in 2014, just about 15% of cases had any “overlap.” But, only 3% of cases had overlap when the actual case was underway. The rest occurred while the patient was in the room before the incision was cut or after the incision was closed. And of those 3%, Medicare strictly outlaws “critical portions” of the case to overlap. This is even more potent as it is generally older, more experienced senior surgeons who perform overlapping surgery. Allowing multiple operating rooms to run allows residents in training to learn more surgery from their master technicians. Most importantly, it allows more patients to receive care from a limited number of top professionals who have decades of irreplaceable experience. Real data from real patients shows concurrent surgery poses no additional complication risk. Many academic centers function as safety net hospitals. Faculty at these institutions treat any person with a surgical disease regardless of their insurance type or ability to pay. For some of our patients, there are no other options. Performing concurrent surgery simply maximizes opportunities for care delivery. It allows more patients to be treated by some of our very best surgeons. To delay care based on sensationalism would negatively impact our most vulnerable patient populations. Most academic centers are also Level 1 (highest) Trauma Centers, meaning their physicians treat the sickest patients after things like gunshots, car accidents, assaults and falls. These, by their very nature, are not planned events. These cases often occur in addition to any planned or elective operations. Under the guides of limiting concurrent surgery, should a neurosurgeon delay or cancel a planned complex elective case for an emergency? How would you feel if your child’s brain tumor case was cancelled or delayed? It shouldn’t have to be that way. Three separate academic studies released through the Mayo Clinic,University of Utah and Massachusetts General Hospital have proven that concurrent surgery poses no additional complication risk. This is real data from real patients. We, as a society, already tolerate concurrent treatments throughout the rest of medicine on the basis of efficiency, so why not adapt the practice to the operating room? A professional dental hygienist cleans teeth in one room while the dentist sees a patient in another. This is a form of concurrent treatment during a single patient encounter by two professionals working within their scope of practice. The dental hygienist cleans, inspects and images the teeth. The dentist evaluates and fixes them. The dentist is ultimately responsible for the patient outcome. This is an effective workflow that maximizes the dentist’s ability to treat patients. If we had to wait for an appointment for a completely supervised autonomous dental visit we would be grinding our teeth. Now, there is a difference. There is an absolute trust, a vulnerability to the asleep patient. It is the duty of the surgeon to openly and properly communicate with their patients. This is a given.Patients absolutely need to know. There is a different level of responsibility. At all times, the focus must be on the patient. And, the governing body of neurosurgery states this bluntly in their position statement on the issue: “The fundamental basis of the patient-physician relationship is trust. It is the glue of the sacred bond between patients and physicians…” But, also, the fundamental ethos of a surgeon is to take action to heal sick people, not to worry about logistical bureaucracy. Let’s cut through the red tape. Let’s let them operate. Let’s let them help as many people as possible. Source
