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Concurrent Surgery and Informed Consent

Alexander Langerman, MD, SM1
[+] Author Affiliations
1Department of Otolaryngology and Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, Tennessee
JAMA Surg. 2016;151(7):601-602. doi:10.1001/jamasurg.2016.0511.
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This Viewpoint examines the practice of concurrent surgery and the need to discuss with patients when and why a surgeon may be absent during noncritical portions of a procedure.

Few patients know what it is like to perform surgery, train residents, or be in an operating room (OR). This is understandable; during most operative cases, patients are sedated or anesthetized, and the modern OR is sealed to casual observers for multiple reasons including infection control and privacy. Television often portrays the OR dramatically and rarely depicts the careful but routine manner in which surgical teams conduct patient care. This translates to information asymmetry, where we as surgeons know much and our patients know little about what will happen during their operation.

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Concurrent Operating Rooms (ORs)

The planned schedule has implications for informed consent. A, Staggered cases are less efficient with surgeon time, but eliminate the risk of critical portions of cases occurring at the same time. B and C, When cases overlap, there is a risk that an unexpected event in one room will keep the surgeon longer than expected. D and E, Simultaneous cases may not be appropriate except in very select circumstances and deserve scrutiny to ensure patient care is not being compromised. With better data on when and for how long critical portions of cases are likely to occur, intelligent schedules could be designed to minimize the risk of concurrent critical portions.

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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