Is Your Surgery Double-Booked?

Do you have a surgery scheduled? It's entirely possible that the surgeon supervising your procedure could be operating on another patient in another room, while your surgery is underway. It happens all the time -- whether you're aware of it or not.

New guidelines put forth in April by the American College of Surgeons say patients should be informed if the surgeon who's doing a procedure is planning to manage another overlapping surgery. But though such guidelines are influential, they're not legally binding, and experts say it's common practice for patients to be left in the dark if the supervising surgeon is going to be out of the room for at least part of the procedure, performing surgery on another patient.

[See: 7 Reasons to Call Off a Surgery.]

The new guidelines come amid fallout from a Boston Globe investigation reporting that some medical staffers at Massachusetts General Hospital complained that the practice of surgeons managing overlapping operations was unsafe and that frequently, patients weren't aware of it. Nationwide, experts say surgeons commonly supervise overlapping procedures -- particularly in teaching hospitals, when, say, an assisting surgeon undergoing additional fellowship training will be tasked with sewing up the patient following a procedure, while the lead surgeon moves on to the next procedure.

Although Centers for Medicaid and Medicare Services rules deal with procedures that overlap, the new ACS guidelines explicitly state "the patient needs to be informed" if an overlapping procedure is planned. The guidelines also distinguish between so-called overlapping procedures versus simultaneous or concurrent surgeries in which the "critical" or "key" components of procedures a surgeon is managing overlap. "That's not appropriate," says ACS Executive Director Dr. David Hoyt. "Concurrent surgeries [are] something that should not be occurring."

The critical components of a heart bypass surgery, for instance, would include sewing the arteries together, Hoyt says, while the initial incisions or final sutures of the procedure might not be considered critical. Similarly, placing a prosthesis would be a key component of joint-replacement surgery. Ultimately, the ACS guidelines say it's the surgeon's responsibility to determine what is and isn't a critical component of the procedure, though, which has drawn criticism from some surgeons as well as Sen. Chuck Grassley, R-Iowa. He's questioned publicly how the status quo would be changed by the new ACS guidelines, since they still allow the surgeon to determine what's considered the critical part of the procedure.

Massachusetts General Hospital disputes the Globe's reporting that medical staffers there complained about at least 44 alleged problems involving concurrent surgeries between 2005 and 2015. "We applaud the ACS for issuing these guidelines. They are similar to the policy we adopted in 2012," MGH spokeswoman Peggy Slasman said in an emailedstatement provided to media. "We will carefully review our policy in light of these guidelines and consider clarifications or modifications as seem appropriate."

One patient, 45-year-old Tony Meng, who the Globe reported emerged paralyzed following a 2012 spine surgery during which the surgeon was running two operating rooms at the same time, has sued the physician for malpractice. In court filings, Dr. Kirkham Wood, who is now a professor at Stanford University, has denied any wrongdoing, the newspaper reports.

[See: 5 Common Preventable Medical Errors.]

CMS rules prohibit surgeons from overlapping critical parts of procedures. But some experts say surgeons have too much discretion in determining what's critical -- potentially leaving patients on the operating table in harm's way.

"I think there has to be a firmer standard for what constitutes a critical part of the surgery," says Dr. James Rickert, president of the Society for Patient Centered Orthopedics -- a group of orthopedic surgeons advocating for patients' interests -- and an assistant clinical professor of orthopedic surgery at Indiana University School of Medicine in Bloomington, Indiana. "There can be a problem at any time during a surgery," he says, adding that it can be difficult to align surgery schedules. "There would certainly be times when the patient would be in the OR waiting for the surgeon to finish what they were doing before the fellow could proceed further ... it's not like a train schedule." Rickert notes he doesn't have occasion to do overlapping surgeries -- he neither performs surgery at a large teaching hospital nor works with surgical fellows -- but that he's still philosophically opposed to the practice. When surgeons perceive the arrangement as a potential liability, he thinks they are less likely to disclose information about the arrangement with patients, too -- or use euphemisms that don't give patients the full picture.

"I think that the patient, who is paying the bill and taking all the risk, should have some say," he adds. Rickert believes that if there will be procedure overlap, doctors should inform patients well in advance of a procedure, so patients can take that into account when deciding whether to have that surgeon perform their procedure.

Countering criticism that ACS guidelines don't go far enough to provide guidance on what are key or critical components of surgery, Hoyt says most hospitals define parameters that surgeons have to practice within, and he reiterates that longstanding CMS rules probibit surgeons from managing operations where the critical parts overlap. "The American College of Surgeons cannot write a definition for the critical portion of every operation that exists, and there will be some variability depending upon who you're working with," he says -- noting that a supervising surgeon will consider the level of training of a surgeon assisting in the procedure, for example. Ultimately, he adds, it's the responsibility of the surgeon to take care of the patient. "So that can't be relinquished," Hoyt says.

[See: 10 Ways to Prepare for Surgery.]

Rickert recommends that patients clarify what parts of the operation their surgeon will -- and won't -- be in the room for. "It's incumbent on the physician who plans to essentially be two places at once to explain it to the patient, and make the patient comfortable, and make sure the patient's knowledgeable about what's going on," he says. If a patient feels ill at ease and would like the surgeon to be in the operating room for a greater portion of the procedure or the entire surgery, experts say the patient should voice those concerns and, if necessary, find another surgeon.

Michael Schroeder is a health editor at U.S. News. You can follow him on Twitter or email him at mschroeder@usnews.com.