ACS updates guidelines regarding overlapping surgeries The American College of Surgeons (ACS) has updated its guidelines with regard to the practice of one surgeon performing in two surgeries scheduled at the same time as part of a document ‘Statements on Principles’, revised by ACS April 12. • ACS advises against concurrent or simultaneous surgeries and defines them as those in which "the critical or key components of the procedures for which the primary attending surgeon is responsible are occurring all or in part at the same time." • A primary attending surgeon's involvement in concurrent or simultaneous surgeries on two different patients in two different rooms is not appropriate. But overlapping surgeries are different, and may be appropriate. For instance, if key or critical elements of the first operation are finished, freeing up the primary attending to start an operation in another room while others finish the first operation. • As part of the preoperative discussion, patients should be informed of the different types of qualified medical providers that will participate in their surgery (assistant attending surgeon, fellows, resident and interns, physician assistants, nurse practitioners, etc.) and their respective role explained. If an urgent or emergent situation arises that require the surgeon to leave the operating room unexpectedly, the patient should be subsequently informed. • The guidelines are important in clarifying the differences between concurrent, overlapping, multidisciplinary and sequential operations. • Patients have a right to know these details. Most patients will have few, if any, concerns with overlapping surgeries as long as their surgeon is present for the critical portion of the operation and they are informed, and agree to, the surgeon who will be performing the noncritical portions of their operation. • Surgeons will need to have discussions about what 'critical portion of the operation' means and who might be performing some of the noncritical portions of the operation.