American Society of Plastic Surgeons
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STATE | Concurrent Surgery Triggers Changes to Surgical Informed Consent

As reported in the March issue of Plastic Surgery News, concurrent surgery has been scrutinized since a December 2015 report in the Boston Globe, which explored a day at Massachusetts General Hospital in which two spinal surgeries scheduled to start within minutes of each other were performed by one surgeon on two different patients in different O.R.s. One of the patients suffered from subsequent paralysis. Although the Globe states that there is no known connection between the complications and the concurrent procedures, it also asserts that none of the patients or surviving family members knew their surgeons were working on other cases at the same time.

Triggered partly by the exposé, the U.S. Senate Finance Committee investigated the issue of concurrent and overlapping surgeries. In December 2016, the Committee issued a report that called for a ban on concurrent/simultaneous surgeries and for stricter guidelines on overlapping surgeries. ASPS has worked to develop a Policy Statement on Concurrent Surgery that addresses both patient safety and transparency.

With respect to transparency, the Society's Policy Statement lays out best practices for both surgeon-patient communications and informed consent.

Best Practices - Surgeon-Patient Communication

As part of the pre-operative discussion, patients should be informed of the different types of qualified medical providers who will participate in their surgery (residents, fellows, nurses, physician's assistants, nurse practitioners, surgical assistants, or another attending of similar training under the primary attending surgeon's personal direction) and their respective roles. If an urgent or emergent situation arises that requires the primary attending to leave the operating room unexpectedly during a critical portion of the procedure, the patient should be subsequently informed.

Best Practices - Informed Consent

It is important that the patient completely understands the procedure, possible complications, and likelihood for additional surgery in the future. As with all surgical procedures, appropriate informed consent is required. The education process associated with an informed consent should help the patient understand the risks, benefits and potential complications associated with a particular procedure.

According to Society's Policy Statement, the surgeon should explain to the patient that he/she may exit the operation before it's completion and that qualified surgical personnel will be present at all times during the operative procedure. Hence, the patient should be informed during the consent process that the primary surgeon may not be physically present in the operating room for the entire duration of the surgery, but will be present for the critical portions of the procedure.

On the legislative front, states have started to address enhanced informed consent requirements. Recently, ASPS commented on a regulation proposed by the Massachusetts Board of Registration in Medicine that would require physicians to report a list of all health care providers participating in a patient's procedure within the patient's medical record, as well as any absences of the attending physician. ASPS commented on this regulation and noted the increased administrative burdens that this proposal will place on solo and small practice physicians who will have to obtain written informed consent for non-invasive diagnostic and therapeutic procedures. ASPS is currently tracking legislation and regulations pertaining to concurrent surgery and related changes to informed consent nationwide.