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Overlapping and Concurrent Surgery: Striking the right balance of optimizing surgical care and neurosurgical training, with informed and safe patient care

HSGuest post from:

Alan R. Cohen, MD, FAANS, president, Society of Neurological Surgeons
Frederick A. Boop, MD, FAANS, president, American Association of Neurological Surgeons
Christopher I. Shaffrey, MD, FAANS, chair, American Board of Neurological Surgery
Russel R. Lonser, MD, FAANS, president, Congress of Neurological Surgeons
Shelly D. Timmons, MD, PhD, FAANS, chair, AANS/CNS Washington Committee

Recently, the topic of concurrent and overlapping surgery has been the focus of significant attention in the media and by state and federal policymakers — in particular, the Boston Globe Spotlight Team and U.S. Senate Finance Committee. As most neurosurgeons know, overlapping operations are performed routinely and safely at many health care centers, particularly at academic medical centers and trauma centers. To help provide clarity about the many facets of this issue, the One Neurosurgery Summit organizations — the American Association of Neurological Surgeons (AANS), American Board of Neurological Surgery (ABNS), Congress of Neurological Surgeons (CNS), Society of Neurological Surgeons (SNS) and AANS/CNS Washington Committee — collaborated to produce a position statement addressing the intraoperative responsibility of the primary neurosurgeon. The statement builds on the American College of Surgeons’ “Statements on Principles.”

osThese guidelines recognize that the fundamental basis of the patient-physician relationship is trust and the belief by patients that if they put their lives in their neurosurgeons’ hands, neurosurgeons will do their best to ensure an optimal outcome. The issue of overlapping and concurrent surgery, therefore, encompasses three key features: providing patients with the information they need to make informed decisions, training the next generation of neurosurgeons and ensuring patient safety. Pursuant to these tenets, the primary attending neurosurgeon is personally responsible for the patient’s welfare throughout the operation. In general, the patient’s primary attending neurosurgeon should be in the operating suite or be immediately available for the entire surgical procedure. There are instances consistent with good patient care which are valid exceptions. However, when the primary attending neurosurgeon is not present or immediately available, another attending neurosurgeon should be assigned to be immediately available. Specifically:

  • A primary attending neurosurgeon’s involvement in concurrent or simultaneous surgeries on two different patients in two different rooms is not appropriate.
  • A primary attending neurosurgeon may be involved in two overlapping surgeries provided that 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 neurosurgeon to return to that operation.
  • The neurosurgeon may delegate part of the operation to qualified practitioners under his or her personal direction including, residents and fellows. However, the primary neurosurgeon must be an active participant throughout the key or critical components of the operation.
  • Neurosurgeons must fully inform every patient about his or her illness and the proposed treatment. As part of the pre-operative discussion, patients should be informed of the different types of qualified medical providers that will participate in their surgery (assistant attending neurosurgeon, fellows, resident and interns, physician assistants, nurse practitioners, etc.) and their respective role explained.

The mission of organized neurosurgery is to advance the quality of care of neurosurgical patients while promoting excellence in education and research. We believe these principles strike the appropriate balance of optimizing surgical care and neurosurgical training, with informed and safe patient care.


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