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Multiple-Room Surgery Stirs Strong Opinions

Multiple-room surgery is a hot topic dominated more by opinion than data. That may change during a Tuesday Miniseminar when the results of a survey of otolaryngologists are released and discussed.

“Overlapping/Concurrent  Surgery: Definitions, Data, Debate, and Destiny” will be presented from 1 pm-2 pm Tuesday in Room 26

“There are little data in the literature regarding this practice and how much it is done, particularly among otolaryngologists, and in what situations and settings it is done. The Academy’s Patient Safety and Quality Improvement Committee designed a survey study that was approved by the leadership of the Academy and sent to the membership to get more data and insight around this issue,” said Brian Nussenbaum, MD, session moderator.

The session will look at the pros and cons of the topic, sometimes synonymously described as multiple-room surgery, overlapping surgery, and concurrent surgery. Dr. Nussenbaum and four speakers will present the background, how the American College of Surgeons recently defined it, and practical issues that surround the topic. In addition to the AAO-HNSF survey results, original data will be presented on overlapping surgeries related to reconstruction.

The long-simmering topic moved to the front burner when the Boston Globe reported its use at Massachusetts General Hospital, generating a lot of feedback from surgeons and the general public, said Dr. Nussenbaum, who is the Christy J. and Richard S. Hawes III Professor of Otolaryngology-Head and Neck Surgery at Washington University School of Medicine, St. Louis.

“It led a leadership group from the American College of Surgeons to write a document that more clearly defined the different situations of multiple-room surgery, and specifically defined overlapping surgery and concurrent surgery,” he said. “The document also described ethics related to informed consent of patients when this is occurring.”

In response to the newspaper article, Alexander Langerman, MD, MS, assistant professor at Vanderbilt University Medical Center, Nashville, TN, wrote an opinion column for the Boston Globe. He will speak at the Miniseminar.

“Concurrent surgery is a good idea, as long as schedules are designed so attending surgeons are present and focused for the portions of the case that require their advanced skills,” he said. “This avoids excess surgeon downtime due to non-surgical tasks like room cleaning and anesthesia time, or even simple tasks that might appropriately be delegated to trainees or assistants.

“With careful management, a single surgeon can care for more patients in a given operative day, increasing access to and decreasing wait times for specialized care.”

Multiple-room surgery obviously remains a hot topic for both professionals and the general public.

“Just about any surgeon throughout their career—whether it was during residency or afterward—has either done this or experienced it,” Dr. Nussenbaum said. “There are strong feelings on both sides that have impacts on several domains. It is a timely topic that has practical importance and potential impact on every otolaryngologist in terms of their practice.”

Also speaking at the session will be:

  • James C. Denneny III, MD, AAO-HNS/F executive vice president and CEO.
  • David M. Cognetti, MD, associate professor of otolaryngology—head and neck surgery at Thomas Jefferson University, Philadelphia, PA
  • Larissa Sweeny, MD, a resident physician the University of Alabama at Birmingham, Department of Surgery, Division of Otolaryngology, Head and Neck Surgery

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