A study of more than 90,000 hip operations at hospitals in Ontario found when surgeons were overseeing two operations at once, patients were nearly twice as likely to experience serious complications, with a longer overlap increasing the risk.

“If your surgeon is in multiple places, there’s an increased risk of having a complication,” Bheeshma Ravi, MD, PhD a hip surgeon at Sunnybrook Health Sciences Centre in Toronto and lead author of the study published in JAMA Internal Medicine, told the Boston Globe. “I think that just makes sense.”

Double-booked surgeries has generated controversy at other hospitals, especially when done without the patient’s knowledge. The Globe itself reported in 2015 on a debate at Massachusetts General Hospital over whether the practice was safe. Since then, seven other peer-reviewed studies have found no significant differences in quality when surgeons are overseeing multiple operations—but opponents of concurrent surgeries said this study, collecting data from multiple facilities rather than a single hospital or outpatient clinic, provides better data.

“This study shuts the door on the idea that simultaneous surgery is as safe as solo surgery, when the doctor’s just concentrating on you,” said James Rickert, MD, an Indiana orthopedic surgeon and president of the Society for Patient Centered Orthopedics. “The size, the numbers, the multiple institutions and the long-term follow-up dwarf any of those other studies.”

While more common among patients whose surgeries overlapped, complications were still found to be relatively rare. For hip replacement patients, the risk of complication increased from 1.4 percent to 2.3 percent. For more urgent hip fracture procedures, the risk rose from 6.4 percent 10.4 percent.

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