Risk of Complications in Double-Booked Surgeries Should Be Part of Informed Consent: Report

Surgeons who schedule overlapping procedures, known as “double-booked” surgery, may place patients at a higher risk of experiencing complications, according to the findings of new research, which suggests that the common practice should be part of the informed consent given to patients. 

In a study published this month in the medical journal JAMA Internal Medicine, Canadian researchers report that patients who undergo surgery by a surgeon who is overseeing two patients at the same time may experience higher rates of complications later on.

Researchers from Ontario, Canada, analyzed data from 75 hospitals from 2009 to 2014. They focused on patients in two large cohort studies, which included patients from a hip fracture study and a hip arthroplasty study, or total hip replacement.

The study included 38,000 patients over 60 years old who underwent surgery for hip fractures, with a total of 960 that were overlapped with other surgeries. The second study included 53,000 patients older than 40 years of age who underwent hip arthroplasty, 1,560 of which overlapped with other surgeries.

Researchers followed patients for up to one year after surgery. This offered a more complete picture of a patients recovery and how overlapping surgeries may affect outcomes in the long run.

Scheduling double-booked surgeries, or overlapping procedures, is a common practice among some surgeons. The practice is controversial, with some studies linking it to negative outcomes. Other surgeons stand by the practice as a way for more patients to see top surgeons who are in high demand.

The new study found that patients who were double-booked had twice the risk of experiencing serious complications than those whose doctors focused on only one surgery at a time. Researchers also noted that the longer the overlap between surgeries the higher the risk the patients experienced concerning serious complications. Some patients experienced infections or required followup surgery.

The complication rate for patients undergoing hip surgeries increased by 80% to 90% if the patient was a double-booked patient, even for as little as 30 minutes. The risk of complications increased 7% for every 10 minutes that a patient was overlapped, or double-booked, with another surgery.

Researchers said the average surgery overlapped between 30 to 60 minutes. However, some surgeries were double-booked for as long as 3 hours, greatly increasing patient risk.

Despite the increased risk, researchers noted the overall risk was still low. The complication risk for hip replacement surgeries increased from 1.4% to 2.3% if the patient was double-booked. Similarly, the risk for hip fracture surgery increased from 6.4% to 10.4% if the patient was overlapped.

“Overlapping surgery was relatively rare but was associated with an increased risk for surgical complications,” study authors wrote. “These findings support the notion that overlapping provision of surgery should be part of the informed consent process.”