Impact of Overlapping Neuro-Surgeries on Patient Care Quality


  •   Avinash Waikar

  •   Samuel Cappel


Overlapping surgeries, (OS) have been in use in the U.S. where a single surgeon coordinates operative resources with surgical teams for optimal patient care. Preparation for the procedure is completed in one room as a surgical procedure and care for another patient is completed in another. One of the primary drivers of this practice is trauma. In emergent situations, critical patients may require expedited life saving measures, requiring immediate attention and treatment in a second room. Thus, this practice offers quicker access to much needed medical care for the patients who get treated in a timelier manner. Benefits of this practice are decreased time to treatment and usually reduced overall length of stay. Secondly, overlapping surgeries allow optimal allocation of and efficient utilization of the most coveted healthcare resource, “Surgeon Time or Operative Time.” Thirdly, two room practices improve participation opportunities for the surgical residents and fellows. One negative however; is that patients dislike the fact that the attending surgeon is not present in the room for the entire surgical procedure, feeling that the absence of the surgeon could result in less desirable patient care and outcomes. Does the practice of OS really affect the quality of patient care?

This examination of the issue of overlapping surgeries practice and patient care quality involved the collection of data from neuro-surgery involving blunt and penetrating head injuries and spinal cases at a “level one” trauma hospital in the Southern U.S. over a 41-month period. The hypothesis to be tested was that use of a second room will improve patient care by reducing “time to treatment,” decreasing “length of hospital stays,” and decreasing “overall hospital morbidity.” The results showed a significant decrease in “length of stay” (LOS) which could be a result of decreased procedure wait time or earlier intervention. Results also showed significantly fewer medical complications following surgeries that utilized overlapping procedure without a corresponding increase in surgical morbidity. Although overlapping surgery is a contentious topic, which has received unflattering press, we found utilization of overlapping surgeries at this hospital to be safe with reduction in LOS and complications, while reducing required post-surgical rehab in some cases. In conclusion, overlapping surgeries demonstrated positive impact on patient care quality and healthcare resource utilization in this hospital.

Keywords: Healthcare, overlapping, quality


American College of Surgeons (ACS). [Internet] 2016 Available from:

Theriault B, Pazniokas J, Mittal A, Schmidt M, Cole C, Gandhi C, et al. What Does it Mean for a Surgeon to “Run Two Rooms”? A Comprehensive Literature Review of Overlapping and Concurrent Surgery Policies. The American Surgeon. 2019; 85: 420-430 DOI:

Govindarajan V, Ramamurti R. Reverse Innovation In Health Care. Harvard Business Review Press. 2018.

The Boston Globe. [Internet] 2015 Available from:

Zygourakis C, Sizdahkhani S, Keefe M, Lee J, Chau D, Mumman P, et al. Comparison of Patient Outcomes and Cost of Overlapping Versus Non-overlapping Spine Surgery. World Neurosurgery. 2017: 658-664. DOI:

Levin P, Moon D, Payne D. Overlapping and Concurrent Surgery: A Professional and Ethical Analysis. Journal of Bone and Joint Surgery. 2017: 2045-2050. DOI: