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 Researchers focused on what's known as overlapping surgery, when a
senior surgeon performs critical components of one operation at the
same that a trainee surgeon or physician assistant handles a
non-critical portion of another procedure. For example, it might
mean the assistant closes up an incision on one patient while a
senior surgeon begins an operation on another patient.
Only about 4 percent of the 1,454 people surveyed for the study had
heard of overlapping surgery, the study found. Just 31 percent of
them strongly supported the practice once it was explained, and
nearly all of the participants thought patients should be told
before surgery exactly what aspects of their operations might be
handled by a senior surgeon or by a trainee, or resident, surgeon or
an assistant.
"Surgeons should discuss overlapping surgery with patients
beforehand and obtain their consent if this is part of their
practice," said lead study author Dr. Michael Kent of Beth Israel
Deaconess Medical Center and Harvard Medical School in Boston.
Generally, people understand the pros and cons of the practice once
they know what it is, Kent added by email.
"Respondents understood that overlapping surgery allows surgeons to
potentially perform more operations in a given day, so patients may
not need to wait as long for their procedure," Kent said. "They also
understand that complications may occur when a surgeon's attention
is divided, and this may have an impact on patient safety."
For the study, Kent and colleagues surveyed participants about their
knowledge of overlapping surgery, their expectations regarding
disclosure during the informed consent process and their willingness
to have this type of surgery as a patient.
Half of the participants were at least 33 years old, and they ranged
in age from 21 to 74.
During the survey, researchers randomly selected one of three
scenarios to illustrate what happens during overlapping surgery: a
hip replacement, a procedure to remove a brain tumor or a heart
valve replacement. All three scenarios offered similar descriptions
of the roles filled by senior surgeons and assistants.
Overall, about 92 percent of respondents thought surgeons should
document what portion of the operations they were present for,
researchers report in the Journal of the American College of
Surgeons.
When asked specifically about assistants or trainees, 86 percent of
participants thought patients should be told prior to surgery who
would be in the operating room and 84 percent thought the precise
role of trainees should be disclosed.
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After overlapping surgery was described, about 70 percent of
participants thought the practice might be acceptable in certain
circumstances, such as lower-risk procedures or in situations when
an emergency occurred in another operating room.
The survey was done using Amazon Mechanical Turk, an online
crowd-sourcing worksite, and it's possible the participants'
responses might not reflect a broad cross section of the general
public, the authors note.
Also, the study focused on the more accepted practice of overlapping
surgery, not situations, known as concurrent surgery, when one
senior surgeon is in charge of crucial portions of two different
operations at the same time.
Concurrent surgery, is rare and generally should be avoided unless
there's an urgent or unplanned situation, said Dr. Karl Bilimoria,
director of the Surgical Outcomes and Quality Improvement Center at
Northwestern University's Feinberg School of Medicine in Chicago.
Overlapping surgeries, like the kind examined in the study, are more
common and relatively safe, Bilimoria, who wasn't involved in the
study, added by email.
"The resident or physician assistant given this responsibility is
well trained and competent to take on that task without the surgeon
physically present," Bilimoria added. "In many cases, the resident
or physician assistant has done this hundreds or thousands of
times."
SOURCE: http://bit.ly/2m3SLtK Journal of the American College of
Surgeons, online February 11, 2017.
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