Marlene Busko

April 29, 2014

TORONTO, ON — In an academic cardiothoracic surgery center, having one attending surgeon simultaneously run two operating rooms—with residents performing noncritical aspects—did not have a negative impact on surgical complications, length of hospital stay, or operative mortality, researchers report[1].

"Our single-institution data of over 3000 patients [undergoing cardiothoracic surgery] was the first study to systematically compare patient outcomes, and our results show that running two [operating rooms simultaneously] does not increase operative duration, impact starting or closing time, or negatively affect patient outcomes," said lead study author Dr Kenan W Yount (University of Virginia, Charlottesville).

The results imply that a policy of having one attending surgeon for each operating room "is too narrow," he said.

"It must be emphasized that the attending surgeons are scrubbed for the key and critical points of every operation at our institution, and operative plans are reviewed at weekly conferences to ensure that demanding cases are scheduled with appropriate foresight," Yount stressed. Their institution does not allow three concurrent cases.

The results were presented here at the American Association for Thoracic Surgery 2014 Annual Meeting .

Due to increased concerns about patient safely and surgical efficacy, many centers are scrutinizing the policy of allowing one attending surgeon to be responsible for operations in two operating theaters at the same time, but there are no data to guide hospital administrators and others, Yount explained.

The group performed a retrospective analysis of all cardiothoracic surgeries performed at their center from July 1, 2011 to July 1, 2013. They identified 1748 cardiac and 1800 general thoracic surgery cases—20 different types—performed by six surgeons.

Surgeons tended to schedule repeat operations when they were running only one operating room, Yount noted.

Cardiac surgery on days during which an attending surgeon was simultaneously operating in two operating rooms started 11 minutes later. Thoracic surgery done on days when one attending surgeon oversaw two operating rooms finished 20 minutes later.

After controlling for preoperative risk, surgery type, and surgeon, they found that there were no statistically significant differences in operation duration or patient outcome if the surgery was performed when the attending surgeon was running one or two operating rooms.

A study limitation is its short duration, he admitted.

"This study investigates an important question regarding outcomes of surgery that is done in overlapping rooms when the same attending surgeon is overseeing more than one case being done by surgical residents," said the study's assigned discussant, Dr James D Luketich (University of Pittsburgh Medical Center, PA). This information is important to hospital administrators, patients, and third-party payers, he added.

In reply to a question from Luketich, Yount clarified that "simultaneous" major surgery—CABG or lobectomies—really meant "staggered starts." They looked at an overlap of 10 to 45 minutes.

A member of the audience asked what might explain the high level of success. "We try to encourage and develop requisite competence in our trainees early on," Yount commented.

"We do disclose to patients that residents will be intimately involved in their case, as will physician assistants, and the attending surgeon will be there for all critical and key portions," he said in reply to another question.

Yount had no disclosures to report. Luketich receives grant/research support from Accuray and honoraria from Covidien.

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