By Melissa Sirois
In the fall of 2015, a small group of reporters for The Boston Globe published an exposé on the surprisingly little-known phenomena of concurrent, or overlapping, surgeries—namely, those occurring at Massachusetts General Hospital (MGH).
The investigative piece has since provided talking points for several malpractice lawsuits and begs the question, “Is it right or safe for surgeons to run two operations at once?” Concurrent surgery is considered acceptable by some prestigious hospitals and banned at others.
In order to understand why the story and the lawsuits have been so controversial, it’s important to first get a sense of what concurrent surgery is and how it can impact public health.
Dr. Aziz Benbrahim is a surgeon at Midstate Medical Center in Meriden, Connecticut. Midstate is part of the parent practice Hartford Healthcare Medical Group, which is also affiliated with Hartford Hospital, the Hospital of Central Connecticut, Windham Hospital and Backus Hospital.
Benbrahim said concurrent surgeries occur when a surgeon works on more than one patient at a time with the support of a team of medical professionals, sometimes other surgeons, to mainly assist with preparatory tasks and the opening and closure of wounds.
He said this often occurs in situations where patients are undergoing orthopedic surgery, that pertaining to the musculoskeletal system, or cardiac surgery.
According to Benbrahim, there is also a subset of concurrent surgery, something that The Boston Globe’s “Clash in the name of care” may have missed.
“Consecutive surgeries” occur when a surgeon has one or more surgeries booked immediately after one another. When the surgeon finishes stitching up one patient, he or she immediately moves on to the next open room, where all instruments and materials are already sterilized and the patient has just been wheeled in.
In the case of consecutive surgeries, medical staff is much less involved in the actual performance of the surgery and instead work to ensure that the surgeon avoids waiting for a newly cleaned room by simply making two available.
The Boston Globe’s story primarily focuses on Benbrahim’s first definition of “concurrent” surgeries, and it provides arguments from medical professionals and experts on both sides of the issue.
Benbrahim said he doesn’t personally practice concurrent surgery because the work that he does is technically challenging. But those who do practice it, he said, cite the optimization of time and patient volume as driving factors.
Dr. Michael DeBakey, a popular heart surgeon mentioned in “Clash in the name of care,” was an example of someone who often did practice concurrent surgery. It wasn’t unusual for DeBakey to work on three or four patients at a time, the story said, and a fair amount of people in the field said his practices were successful.
Indeed, a concurrent surgery page on MGH’s website cites “timeliness and availability of vital services” and “optimal use of rooms and surgical teams” as a few of its reasons for implementing concurrent surgery practices.
Another reason, according to MGH, is that concurrent surgery allows for greater access to preventative, life-saving services in times of large patient traumas. The website lists the 2013 Boston Marathon bombings as an example of when such “multitasking” was beneficial in maximizing the number of patients treated in the shortest possible time.
There’s also the weight of education. Benbrahim said concurrent surgeries are more likely to occur in teaching hospitals, where residents are being educated and trained.
The Boston Globe said MGH officials “described the practice as an extension of the teaching hospital’s team approach, pairing senior doctors with residents—surgical trainees—and fellows…”
Still, Benbrahim remains unconvinced and continues to question the risk factors associated with performing concurrent surgeries. “The most important patient in a day is the one in the operating room,” he said.
And what happens when a relatively simple surgery goes wrong? Some pending malpractice lawsuits cite concurrent surgery’s role in complications.
According to Benbrahim, patient care, safety and positive outcomes are most important when it comes to performing surgeries. He said he personally doesn’t agree with the idea of concurrency because it seems like “short-changing” patients.
To be clear, though, he said it is not entirely unimaginable that a set of concurrent surgeries could be performed without a hitch. Two important factors need to line up for it to work: a predictable procedure and a “well-oiled machine.”
Benbrahim said that concurrent surgeries are most often streamlined procedures that feature frequently reproduced techniques that very rarely go wrong — obesity and orthopedic surgeries, for example.
Perhaps even more crucial is the effectiveness of the medical team working on the patient — the “well-oiled machine.” He said concurrent surgeries require “an excellent team, all the time, every time,” in order to ensure successful, positive patient outcomes.
While The Boston Globe has undoubtedly uncovered the details of a newly controversial practice, Benbrahim said that generally, “Patients trust the system a lot.”
Over the phone, he mentioned that he had some down time at work after just finishing a robotic surgery.
“Maybe that’s the future,” he said with a chuckle.
Melissa Sirois is a senior journalism major at Quinnipiac University. She is writing about public health this spring. She can be reached at melissa.sirois@quinnipiac.edu.
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