American Association of Neurological Surgeons
American Board of Neurological Surgery
Congress of Neurological Surgeons
Society of Neurological Surgeons
Position Statement on INTRAOPERATIVE RESPONSIBILITY OF THE PRIMARY NEUROSURGEON
Introduction
The fundamental basis of the patient-physician relationship is trust. It is the glue of the sacred bond
between patients and physicians; all other considerations derive from it. This trust is mutual — the belief
by patients that if they put their lives in their neurosurgeons’ hands, neurosurgeons will do their best to
ensure an optimal outcome. A tangible manifestation of this trust is informed consent.
This trust-based obligation extends not just to the individuals neurosurgeons are presently treating, but
also to future patients. To those currently awaiting their services, neurosurgeons owe efficiency in the
use of limited resources, including their time. They must also train the next generation of neurosurgeons
how to provide excellent care for future patients.
These goals of efficiency and training young surgeons may require that a senior surgeon schedule two
operations that overlap and/or delegate portions of an operation to a surgeon-in-training. This
delegation must occur only under circumstances that preserve both safety and trust. Safety is grounded
in the principle of graduated responsibility — as neurosurgeons-in-training accumulate skill, they are
allowed by the senior surgeon to perform more challenging portions of operations with greater
independence. Maintenance of trust requires that neurosurgeons inform their patients of their role in
operations, including the possibility that they may be absent from the operating room during part of the
procedure.
Given that the mission of organized neurosurgery is to advance the quality of care of neurosurgical
patients while promoting excellence in education and research, the following guidelines are
recommended with respect to the issue of “overlapping surgery.”
General Statement
The primary attending neurosurgeon is personally responsible for the patient’s welfare throughout the
operation. In general, the patient’s primary attending neurosurgeon should be in the operating suite or
be immediately available for the entire surgical procedure. There are instances consistent with good
patient care which are valid exceptions. However, when the primary attending neurosurgeon is not
present or immediately available, another attending neurosurgeon should be assigned to be immediately
available.
The definitions at the end of this Statement provide essential clarification for terms used herein.
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