Wrong-site surgery, related injuries appear to be rare

A review of cases reported to one large malpractice insurer over 20 years indicates that wrong-site surgery and related serious injuries are rare and that current national protocols for verifying the surgical site, if applied, may have prevented only two-thirds of cases, according to a study in the April issue of Archives of Surgery, one of the JAMA/Archives journals.

Wrong-site surgery includes procedures that are performed on the incorrect person, organ or limb, or spinal procedures performed at the wrong level, according to background information in the article. Such cases have attracted national attention and mobilized prevention efforts. In 2003, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) developed a protocol that all accredited hospitals must now implement. The three minimum requirements are preoperative verification of site and patient, marking the surgical site on the patient, and the institution of a "time out" in the operating room, the authors write.

Mary R. Kwaan, M.D., M.P.H., Brigham and Women's Hospital and Harvard School of Public Health, Boston, and colleagues examined wrong-site surgery cases reported to one large malpractice insurer between 1985 and 2004. The insurer provides liability coverage to one-third of Massachusetts's physicians and approximately 30 hospitals, which performed a total of 2,826,367 operations during the study period. The researchers searched the insurer's database for malpractice claims and loss observations, which are reports from hospitals to the insurer, related to surgery. They then reviewed text abstracts of the cases they found to identify those that involved wrong-site errors. In addition, information about protocols to prevent wrong-site surgery was collected in 2004 from 28 hospitals covered by four malpractice insurers in New England and Texas.

In their review of insurance records, the authors identified 40 cases of wrong-site surgery, 25 of which did not

Contact: Lori J. Shanks
JAMA and Archives Journals

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