Prof Pandit and colleagues also show, for the first time, that the productivity gains cited in support of overlapping surgery are false. It is inevitable that if an extra operating theatre is available to a single surgeon, then that surgeon’s number of cases will increase as compared with operating from just one theatre. However, it is impossible (for mathematical reasons shown in the paper) for this to exceed the number of the same operations performed by two surgeons in separate theatres. The authors say: “The real question is how productivity of one surgeon working across two overlapping operating theatres compares with two surgeons focused on their own lists.”

That said, overlapping surgery could be useful in the UK NHS in hard-pressed specialties where there are not enough surgeons to staff more than one theatre; or where only one surgeon has volunteered for extra evening/weekend lists where there are anaesthetists and nursing staff available to cover the extra theatres.

They conclude: “Ultimately, any perceived benefits of introducing overlapping surgery should be balanced against the perhaps small, but very real risks it can present to patient outcomes, safety, training and patient autonomy. The experience of Massachusetts General Hospital underlines that there should be advanced agreement and buy-in of all specialties and stakeholders, including patient or lay representatives, before overlapping surgery is introduced. This should be coupled with a programme of education (in the background theory) and training (in the practical workflow changes required) for all staff involved.”

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