academic medical center may involve multiple qualified
medical providers in addition to the primary attending surgeon. As part of the pre-operative 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.
In an effort to provide some standardization of
nomenclature and terminology, the following definitions are provided:
Back-up surgeon/surgical attending
The qualified surgical attending who has been designated to provide immediately available coverage
for an operation, during a period when the primary
surgeon might be unable to fill this role.
“Concurrent or simultaneous
operations” (or surgeries)
Surgical procedures when 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.
“Critical” or “key” portions of an operation
The “critical” or “key” portions of an operation are
those segments of the operation when essential technical expertise and surgical judgment are required
in order to achieve an optimal patient outcome. The
critical or key portions of an operation are determined
by the primary attending surgeon.
Reachable through a paging system or other electronic means, and able to return immediately to the
operating room. This should be defined more completely by the local institution.
Described in ACS Statements on Principles II.A.
One example of this would be a procedure where
a surgeon of one specialty provides the exposure
required by a second surgeon who performs the
main surgical intervention (e.g.; a general or thoracic surgeon providing exposure for a neurosurgeon
or orthopaedist to operate on the spine). Another
example would be an operation that requires the
involvement of two or more surgeons with different
specialty expertise (e.g.; chest wall or head and neck
resection followed by plastic surgical reconstruction;
face or hand transplantation; repair of complex cra-niofacial defects).
“Overlapping or sequenced”
operations for surgeons
The practice of the primary surgeon initiating and
participating in another operation when he/she has
completed the critical portions of the first procedure
and is not essential for the final phase of the first operation. These are by definition surgical procedures
where key or critical portions of the procedure are
not occurring simultaneously.
Located in the same room as the patient.
Primary Attending Surgeon
Considered the surgical attending of record or the
principal surgeon involved in a specific operation.
In addition to his/her technical and clinical responsibilities, the primary surgeon is responsible for the
orchestration and progress of a procedure.
Any licensed practitioner with sufficient training to
conduct a delegated portion of a procedure without
the need for more experienced supervision and who is
approved by the hospital for these operative or patient
D. The Operation—
Intraoperative responsibility of the primary surgeon