Canadian researchers have come up with at least 2,500 reasons why elite surgeons should reconsider their own wishes and practices to protect patients undergoing hip surgeries from significant post-operative complications. They could do so by curbing even more their dual surgeries, in which they dash between two operating rooms.
The Boston Globe, starting in 2015, has raised major issues regarding the safety and effectiveness of simultaneous operations, conducted most often at major academic medical centers (such as Massachusetts General, shown above) and by leading practitioners.
Surgeons say dual procedures allow them to be more efficient, serve more patients, and train other assisting doctors better. They also, of course, increase their earnings and a hospital’s revenues by allowing for the treatment of more patients.
Dueling arguments and studies have been marshaled since, including research on more than 2,000 neurosurgeries. That study found no differences in outcomes between solo versus dual procedures, though simultaneous operations took longer and resulted in patients staying more time under anesthesia.
The Canadian hip surgery research, however, involved more cases and at multiple hospitals. It also followed patients longer. This study focused on more than 90,000 procedures, drilling down on the outcomes for as long as a year later of 960 hip fracture repairs and 1,560 hip arthritis and replacement surgeries — all involving overlapping procedures.
Patients in the dual surgeries suffered more complications, including infections and needed surgical “revision,” especially soon after operations. Researchers faulted the training that occurs as a key component of simultaneous procedures, saying doctors and hospitals should reexamine if less-skilled practitioners should open and close surgical incisions. That basic step can leave patients more prone to infections and other problems if not handled well.
In my practice, I see the harms that patients suffer while seeking medical services, including while undergoing popular and purportedly routine knee and hip replacements. Almost 1 million Americans, many of them baby boomers, have such surgeries each year, and the Medicare spending just to hospitalize patients for the operations is hitting $7 billion. Doctors and hospitals have made progress with these procedures. But make no mistake: They still are major surgeries that can be painful and uncomfortable. They also carry real risks to patients.
Given these hard facts, it’s hard to understand why surgeons try to juggle them. The American College of Surgeons (ACS), in response to the Boston Globe stories and a U.S. Senate committee investigation, has hacked at standards for simultaneous operations: If they conduct “overlapping” procedures, surgeons now are urged not to perform parts of a surgery deemed most critical at or near the same time in each operating room. Medical centers nationwide have banned so-called concurrent operations. But surgeons—supposedly under more rigorous oversight by hospitals— still perform “overlapping” procedures, in which critical parts of operations don’t coincide.
Is it clear enough, though, this distinction between concurrent and overlapping procedures? Can research help clarify the risks and benefits if the differences aren’t well defined?
Patients already have enough to worry about if they’re having a knee or hip replaced. But, especially if the work will be done at a big hospital, they may need to ask if surgeons plan to operate on them and another patient in an “overlapping” procedure. They need to consider how comfortable they may be allowing themselves to be subjects for surgical training—which is a necessary part of medicine.
But if your chosen surgeons are so fancy that they can’t focus just on you, and your operation isn’t a dire or complicated case that might benefit from a super specialist with a hectic schedule, well, there’s another option: Find another doc. Caveat emptor.