How to Avoid Surgical Mistakes

Medication errors like the massive overdose of heparin given to Dennis Quaid’s newborn twins have received a lot of attention, however the National Patient Safety Benchmarking Center found that surgical errors are the most costly and frequent types of medical errors occurring in hospitals today.  A few years ago comedian Dana Carvey had a coronary artery bypass operation where the wrong vessel was bypassed later requiring a repeat operation.  With an increasing shift of surgical procedures away from hospitals, and the difficulty of assessing the number of procedures performed for the wrong diagnosis or poorly performed procedures requiring further surgeries, the true costs both in dollars and suffering are difficult to grasp.  Although our medical care system has made unprecedented advances and helps more people than ever before, it is easy to understand why the prospect of having a medical procedure can create a lot of anxiety and worry.  Here are a few tips to help you avoid becoming the victim of a surgical error: 

  1. Confirm the right Diagnosis: If you have any reservation or concern regarding the diagnosis or plan of treatment get a second or third opinion from an independent physician.

Medicine is complex and your physician has to first be a detective.  Frequently both the patient and physician are afraid to ask:  What else could it be?  In an upcoming article in Arthroscopy, we describe a new minimally invasive technique to address a pinched nerve in the shoulder; the patients in the study each had multiple previously failed operations for their shoulder pain.  The diagnosis of a pinched nerve had not been previously considered. 

  1. Check out your doctor and facility:  I recommend finding a surgeon that performs at least 50 of the specific procedure you are considering per year- meaning on average the surgeon is performing the procedure on a weekly basis.  Ask your doctor how many of the specific procedures he does annually.  Like a professional car racing team having a team and facility that performs the specific procedure you are considering repeatedly is the best way to reduce your chances of a complication. 

The success rates and complication rates reported in the medical journals are done by teams that often only perform that procedure.  However, most shoulder replacements are done by surgeons who perform ten or fewer of these procedures per year.  When Consumer Reports surveyed 1,001 patients having hip or knee replacement at a variety of facilities, they found a 5% infection rate.  This is more than five times higher than reported in several major studies.  For all but the rarest of procedures, both Consumer Reports Data regarding the rate of complications including infections is not readily available to the public for all procedures so ask your surgeon and facility for a rate for the specific procedure directly.  Because the rates of infections and complications vary so greatly there is some resistance to complete disclosure of this information.  Some sources for more information:  (Medicare Website) (Consumers Union )

  1. Take charge of your care: Trust but verify.  Even though the surgical team may do hundreds or thousands of a particular procedure, this is the only one that is important to you.  Make sure everyone you come in contact with someone who knows who you are and why you’re having surgery.  Make sure you see your surgeon and confirm the surgery site before the procedure.  The American Academy of Orthopaedic Surgeons encourages all its members to sign the surgical site before surgery.  A recent article from The New England Journal of Medicine found that a checklist similar to the preflight checklist pilots use makes sure everyone on the team is on the same page, and this reduces the risk of complications.

 Vivek Agrawal, MD, Orthopaedic Surgeon and Medical Director of The Shoulder Center.

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