New Guidelines On Overlapping Surgeries

The American College of Surgeons released new guidelines in April regarding overlapping and concurrent surgeries. The new standards include informing a patient when a surgeon is managing an additional surgery on a second patient. Dr. Kirkham Wood performed two surgeries at Massachusetts General Hospital in 2012. Tony Meng sued the surgeon for malpractice following an eleven hour surgery that left him paralyzed. Meng’s case brought to the forefront the controversy over whether “double-booking” surgeries constitutes safe medical practice.  Meng came to MGH suffering from neck pain and tingling in his arms and fingers. Dr. Wood, Chief of MGH’s orthopedic spine service, performed two complicated surgeries during the same time frame, a cervical corpectomy for Wood’s degenerative spine condition and the second surgery for a spinal fusion patient.

The American College of Surgeons Statements on Principles, revised April 12, 2016:

Concurrent or Simultaneous Operations

Concurrent or simultaneous operations occur when the critical or key components of the procedures for which the primary attending surgeon is responsible are occurring all or in part at the same time. The critical or key components of an operation are determined by the primary attending surgeon. A primary attending surgeon’s involvement in concurrent or simultaneous surgeries on two different patients in two different rooms is not appropriate.

Overlapping Operations

Overlapping of two distinct operations by the primary attending surgeon occur in two general circumstances.

The first and most common scenario is when the key or critical elements of the first operation have been completed and there is no reasonable expectation that there will be a need for the primary attending surgeon to return to that operation. In this circumstance a second operation is started in another operating room while a qualified practitioner performs non-critical components of the first operation allowing the primary surgeon to initiate the second operation, for example, during wound closure of the first operation. This requires that a qualified practitioner is physically present in the operating room of the first operation.

The second and less common scenario is when the key or critical elements of the first operation have been completed and the primary attending surgeon is performing key or critical portions of a second operation in another room. In this scenario, the primary attending surgeon must assign immediate availability in the first operating room to another attending surgeon.

The patient needs to be informed in either of these circumstances. The performance of overlapping procedures should not negatively impact the seamless and timely flow of either procedure.

Litigation following orthopedic surgery most often stems from poor surgical outcomes resulting in loss of function. If the attending surgeon is committed to managing two cases, he or she may be away from one of the patients for an extended period of time.  When complications arise, so does the question of whether “double-booking” is appropriate medical procedure.  Orthopedic surgery experts are able to evaluate and distinguish between overlapping procedures versus simultaneous or concurrent surgeries in which the “critical” or “key” components of the procedures a surgeon is managing occur during the same time frame.

Contact ELITE today to find the right orthopedic surgery expert for your malpractice case.


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