Over Lapping Surgery - Best or Worst Practise?

With 7,285 surgical consultants currently working in the UK and just about another 10,000 trainees and team members making up the rest of the workforce, surgeons in the UK are in high demand. Surgical admissions have increased by 27% from 2003/04 to 2013/14, with the total number reaching 4.7 million procedures being performed. When you factor in the 10 surgical specialisms recognised in the UK as well, this demand becomes all the more incredible given how much pressure is placed on such a small number of experts.

In order to meet the ever-increasing surgical demand from the public, surgeons in certain specialities will perform overlapping procedures. Patients are usually ‘opened and closed’ by junior members of the surgical team whilst experts perform the complex parts of the procedure. The expert then must clean and transport themselves to another operating theatre where they perform yet another complex procedure.

The process is certainly a benefit in the efforts to see as many patients as possible. Specialist surgeons are in high demand and being able to use their time as efficiently as possible means that their time is evenly distributed to the patients who need it the most. As always, the best interest of the patient must be placed at the centre of any decision made. As such, the question of the safety and effectiveness of overlapping surgeries has been raised by a recent report produced by Jama Network, released on the 26th February.

The report revealed that there are many influencing factors with regards to patient safety during overlapping surgical procedures. Older, high-risk patients with underlying health issues were found to have high mortality after surgery 5.8% of the time, compared to 4.7% younger, yet equally high-risk patients. The risk of post-surgery complications compared to overlapping and isolated surgeries for high-risk patients also served as a revealing statistic. 29.2% of high-risk patients experienced post-surgery complications as opposed to 27% otherwise.

This increased risk comes from the split of concentration between operation to operation. The risk of mistakes increases as surgeons are required to actively be in two places at once, thinking about two separate procedures as they move from one operating theatre to the next.

With these statistics in mind, there still stands no real solution to offer as a replacement. The general consensus across professionals remains that overlapping surgeries at the start and end of operations makes better use of a specialist surgeon’s time; especially when specialists are in such high demand. The biggest takeaway from the report is the need to focus more intently on high-risk patients, and avoid booking them in for overlapping surgery.

The act of overlapping surgery, whilst still actively practiced, has begun to be described as ‘inappropriate’ by the American College of Surgeons. But regardless of this label, the fact remains that an increasing demand for surgical procedures from the public is being met by a very small workforce, even smaller when specialisms come into play. Being able to utilise the time of expert surgeons in the best, most efficient, and safest way possible is essential if the increasing pressure is to be alleviated at all.