Is There a Difference in Patient Outcomes if a Surgeon is Involved in Overlapping Surgeries?

JAMA Surgery


Media advisory: To contact corresponding author Brian M. Howard, M.D., email Janet Christenbury at The full study is available on the For The Media website.

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Bottom Line: Overlapping surgery, defined as a surgeon’s involvement in two operations scheduled at the same or overlapping times, appeared safe for patients undergoing neurosurgery.

Why The Research Is Interesting: Surgeons routinely schedule overlapping operations for more than one patient. Concerns about overlapping surgery were summarized in recent JAMA articles and include inadequate informed patient consent, compromised patient safety, and medical ethics. There is little evidence to support or refute these concerns.

Who: 2,275 patients who underwent neurosurgery at Emory University Hospital

When: January 2014 through December 2015

What (Study Measures): Researchers compared deaths, complications and patient functional status within 90 days for patients who underwent overlapping vs. non-overlapping surgeries.

How (Study Design): This was an observational study. In observational studies, researchers observe exposures and outcomes for patients as they occur naturally in clinical care or real life. Because researchers are not intervening for purposes of the study they cannot control natural differences that could explain study findings so they cannot prove a cause-and-effect relationship.

Authors: Brian M. Howard, M.D., of the Emory University School of Medicine, Atlanta, and coauthors

Results: In this large series of mostly complex patients undergoing overlapping and non-overlapping neurosurgery, there was no difference between the groups in deaths, illness, or functional status at discharge and follow-up.

Study Limitations: The surgeries were performed at a single academic neurosurgical referral center.

Study Conclusions: These data suggest overlapping surgery can be safely performed and has the potential to make sought-after specialists available to a greater number of patients.

Featured Image:

What the Image Shows: The diagram illustrates the ways surgeons may participate in overlapping surgeries during critical and non-critical phases of the operation.

Related material:

The following related elements also are available on the For The Media website:

  • The commentary, “Overlapping Surgery – Opportunities in Neurosurgery Based on New Research,” by David B. Hoyt, M.D., of the American College of Surgeons, Chicago

For more details and to read the full study, please visit the For The Media website.


Editor’s Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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