Dr. Robert Booth Jr.
Aria 3B Orthopaedic Institute, Pennsylvania
Orthopedic surgeon who settled charges of overbilling Medicare for simultaneous cases
Voices from the operating room
Surgeons are divided on the wisdom of starting a second operation before the first one is complete. Some say that concurrent surgery is stressful for them and potentially hazardous to patients, while others say that "running two rooms" greatly increases their efficiency and can be done safely. And, for the first time, many of them are talking about concurrent surgery publicly. Read the story.
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The majority of high volume joint surgeons have two rooms that they run. They have to sit around for something magically called turnover time which is very variable from one site to another ... To say it’s harming patients is a little surprising to me. I’d like to know what harm is done.
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Over time I decided it was really not a very good practice for the sake of patients and I stopped doing it. It was too stressful for me.
Dr. Robert Pedowitz
UCLA Medical Center, California
Former chief of orthopedics
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I run two rooms to eliminate excessive turnover time between cases. At the end of a case during closure I will notify the OR to start the process to get the next case ready so there is a shorter time to wait between the end of a case and the start of the next case.
Dr. James Andrews
Florida
Orthopedic surgeon and consultant to the NFL’s Washington Redskins
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There are ways to run two rooms properly — Medicare recognizes that — and there are ways not to do it, and most of the angst usually stems from people doing it poorly.
Dr. Allan Kirk
Duke University Health System, North Carolina
Surgeon-in-chief
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I believe that leaving residents entirely unsupervised during a surgery is dangerous, and because of that, I simply could not keep silent.
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Not all surgeons should have two rooms. You have to be a relatively quick surgeon … The average time for a total shoulder replacement in the US is 2.25 hours. I do it in 35 to 40 minutes. I do 900 shoulders a year. If that’s the case, and I have to wait around for a room for an hour for a total shoulder that is just dumb. If you can’t do a total shoulder in an hour you can’t have two rooms, ethically. I just did nine surgeries for today. I was done by four. I am about to go to the gym. I can get patients done in a reasonable manner in two rooms.
Dr. Reuben Gobezie
University Hospitals, Ohio
Shoulder surgeon
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I’m pretty hands on, so for me I think running multiple rooms at the same time is not ideal. I like to be there for the entire case — from when the patient rolls in to when the patient wakes up.
Dr. Mininder Kocher
Boston Children’s Hospital
Orthopedic surgeon
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It’s more efficient to have your engine, your surgeon, utilized as much as possible during the day.
Dr. Brian Parsley
Memorial Hermann, Texas
Orthopedic surgeon
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Allowing a surgeon to run two rooms may be most efficient from the surgeon’s perspective since it allows him or her to stay engaged in the conduct of operations continually, doing more cases per day and perhaps, maximizing financial gain. But it is inefficient from every other perspective since it inevitably leaves the second OR (and the attendant team) idle for periods of time while the surgeon is in the first OR.
Richard Boothman
University of Michigan Health System
Executive Director of Clinical Safety, Chief Risk Officer
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Staggering cases is where two rooms are used to improve surgeon efficiency for short cases that last a shorter duration than the time needed by anesthesia to wake up one patient, clean the room and put another to sleep. There may be one or more surgeons involved in this case. This practice is more common and involves surgeons who have shorter operative times. In our case we stagger the rooms so that one surgeon can finish one case and the other is just getting ready to start.
Dr. Vipul Patel
Florida Hospital
Urologist and Medical Director of the Global Robotics Institute
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In the last years, we have been more cognizant about the wait time. We try to stagger and move cases with more analytics ... We have gotten so much better at predicting or using our ORs that those kinds of events are uncommon.
Dr. Robert Cima
Mayo Clinic, Minnesota
Vice chair of the surgical and procedural committee
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For all of my training and for my whole career, we have utilized 2 rooms to increase efficiency. The way I do it is to run two adjacent OR rooms in a staggered fashion, not concurrently. I am considered an efficient surgeon and this works well for me. Typically, for the types of cases that I perform (1.5 to 2 hours of operative time), there is effectively 1 to 1.5 hours of down time between cases where the surgeon is not needed.
Dr. Peter Millett
The Steadman Clinic, Colorado
Orthopedic surgeon who has treated elite professional athletes
Produced by Russell Goldenberg and Elaina Natario