WRONG SIDED SURGERY–ARE WE THERE YET?

Abstract

Purpose: Wrong sided surgery is a devastating, yet avoidable adverse event. The Committee on Orthopaedic Practice & Economics (COPE) position paper on wrong sided surgery in Orthopaedics in 1994 had proposed to develop a reproducible method of operating on the correct side and to educate the orthopaedic community about the standardized procedure and accept this as the standard of care. An update to the COA Membership on success of the position paper was published in the COA Bulletin in 2002. Correspondence from the Canadian Medical Protective Association (CMPA) had demonstrated that there were some encouraging results. There had been a reduction from approximately 13 cases per year in 1987 to five cases per year in 2000. The most common anatomical site involved the incorrect knee. Now 10 years after its acceptance as the standard of care in Canada for orthopaedic surgeons at the COA Meeting in 1995, have all cases of wrong sided surgery been eliminated?

Methods: A search of the CMPA files of malpractice claims as well as cases that were labeled as threats occurring between January 2001 and September 2005 naming a physician and involving the issue of wrong sided surgery were performed.

Results: A review of the synopses found 26 cases where wrong site surgery was the central issue. There were 9 cases in 2001, 10 in 2002, 3 in 2003, 3 in 2004 and 1 in 2005. The 26 cases were reviewed in detail and some of the general characteristics were identified. Of those 26 cases, 10 involved the incorrect knee; in 9 cases, an arthroscopy was performed on the wrong knee; in one case, a total knee replacement was performed on the wrong knee. Hand and foot cases usually involved the wrong finger or toe.

Conclusions: Despite the position paper from the COA (OPERATE THROUGH YOUR INITIALS), operating room policies, heightened awareness, information and educational sessions at all levels of training, wrong site surgery continues to recur. Review of the files for risks have identified the following trends: patients had been anesthetized, the extremity prepared and draped without the surgeon seeing the patient first, the surgical area had been marked by a person other than the surgeon, the medical record and/or radiographs were not available in the operating room, and the hospital policy was not followed. Surgeons need to be mindful that wrong sided surgery has not been eliminated, and educate their surgical team in its prevention.