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J Am Coll Surg. 2018 Apr 12. pii: S1072-7515(18)30257-6. doi: 10.1016/j.jamcollsurg.2018.03.037. [Epub ahead of print]

Concurrent Surgery and the Role of the Pediatric Attending Surgeon: Comparing Parents' and Surgeons' Expectations.

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Department of Surgery, Yale School of Medicine, New Haven CT. Electronic address:
Department of Surgery, Yale School of Medicine, New Haven CT.
Department of Medical Sciences, Frank H Netter MD School of Medicine, North Haven CT.
Department of Surgery, Yale School of Medicine, New Haven CT; Department of Transplantation, Primary Children's Hospital-Intermountain Healthcare, Salt Lake City UT.
Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven CT.



The common practice of performing concurrent or overlapping surgeries has been intensely scrutinized by lay media and academic press to investigate its safety and cost-effectiveness. However, there is little information about its use within the pediatric population. Even less is known about parents' expectations regarding the surgeon's role on the day of surgery and how they align with those of pediatric surgeons and surgical trainees, despite the potential for significant discrepancies in expectations to erode trust and damage the physician-family relationship.


A five-point Likert-style survey was designed to characterize expectations regarding the degree of involvement by pediatric attending surgeons throughout a surgical case (1 = strongly disagree, 3 = neutral, 5 = strongly agree). The survey was administered to parents of pediatric patients undergoing elective surgery during a 3-month interval at a single academic institution. The survey was also administered to surgeons and surgical residents at the same institution. Multivariate-multiplicity adjusted t-tests were used to identify significant differences between responders.


110 parents and 84 pediatric surgeons and trainees completed the survey. Parents' responses to the survey ranged from 4.15 to 4.89, compared to 2.75 to 4.86 from surgeons. The differences achieved statistical significance (p<0.05) for eight out of nine statements. Statistically significant differences were fewer, but still present, between attending surgeons and surgical trainees, as well as between surgeons with and without children.


There is a significant mismatch between parents' expectations and those of pediatric surgeons regarding the role of the surgeon on the day of surgery, with parents consistently expecting more direct involvement by the attending surgeon. These discrepancies may have implications for both parent/patient satisfaction and medical education.


Expectations; concurrent surgery; overlapping surgery; pediatrics; surgery

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