Not Without My Attending: A Survey of Patient and Family Member Attitudes and Perceptions About Concurrent and Overlapping Surgery.

Abstract Background Context Recent media coverage of overlapping surgery has led to several studies investigating public perception of concurrent and overlapping surgery, both of which involve a single attending surgeon working on two separate cases in two separate operating rooms. In concurrent surgery, the critical periods of the surgeries overlap, while in overlapping surgery they do not. The literature revealed a general lack of knowledge about these practices and strong disapproval of their use by the public. Purpose To determine the comfort level of spine surgery patients and their family members toward concurrent and overlapping surgery. Study Design/Setting This cross-sectional survey study was performed at an urban, adult academic spine surgery clinic. Patient Sample Patients and their companions who were waiting to be seen at their initial clinic visit or follow-up visit were approached to participate in the study. Outcome Measures The survey queried respondents’ baseline knowledge of and comfort level with concurrent and overlapping surgery, in addition to comfort level with different levels of surgical trainees on a 5-point Likert scale. Methods A five-section, 36-item questionnaire was administered by a research assistant to respondents over a three-month period spanning June 2019 – August 2019. A research assistant described the terms overlapping surgery and concurrent surgery to participants of the survey using diagrams and a pre-formulated script after self-reported knowledge questions. Statistical analysis was performed using the chi-square test for categorical variables, and Kendall's tau-c rank correlation coefficient with ordinal independent variables for correlations. Results Knowledge about concurrent and overlapping surgery was low in our study population (8.22% and 6.16%, respectively). Over half of respondents reported that they felt comfortable with overlapping surgery (58.22%). Most respondents reported that they would like their surgeon to disclose the participation of surgical trainees (residents and fellows) in their surgery (98%). In addition, the 4th and 5th years of surgical training were associated with a significant increase in patient comfort with surgical trainee participation. There was no difference in response distribution between patients versus non-patients. Conclusions Knowledge about concurrent and overlapping surgery remains poor in our study population. Lack of general knowledge about overlapping surgery can be a serious impediment to obtaining informed consent, and further study is required to determine the best methods to raising patient awareness.