Advance Access: HIMS: Comparison of Patient Outcomes in Three Thousand Seven Hundred Twenty-Five Overlapping vs Three Thousand Six Hundred Thirty-Three Nonoverlapping Neurosurgical Procedures Using a Single Institution’s Clinical and Administrative Database

Overlapping surgeries are also known as concurrent or simultaneous procedures. They occur when a single attending surgeon “runs 2 rooms” at the same time, so that cases in 2 separate operating rooms (ORs) have overlapping procedure times (Figure 1).1 The American College of Surgeons and the major neurosurgical societies further distinguish between overlapping procedures (in which the primary surgeon performs the critical portion of the procedure, but others assist with opening and closure) vs concurrent procedures (in which the critical portion of the procedure occurs simultaneously in 2 different operating rooms).2,3 In our neurosurgical department, many surgeons routinely perform overlapping surgeries assisted by cosurgeons, residents, and fellows, who are present throughout the duration of the case and perform noncritical portions of the procedures. Overlapping surgery is thought to improve efficiency, encourage surgical education for residents and fellows by promoting autonomy, allow for cases to be done with daytime staff (instead of late into the night with a less experienced team), and allow faster access to high-demand specialty surgeons.1

This practice has recently come under close scrutiny, after a case with a poor outcome at Massachusetts General Hospital (MGH).1,4 The patient had not been informed that his surgeon would be running 2 rooms, a practice that is now well disclosed to every patient before undergoing surgery at MGH.5 This case also prompted a senate inquiry into the safety of overlapping surgery,6 which despite being common in hospitals across the country, has not been rigorously studied.

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