Surgeons urged to think again before cutting

More than one-third of orthopaedic surgeons operate on the wrong body site at least once in their career, says a Christchurch surgeon.

A conference has also been told of "near misses", including two Christchurch cases last year when the wrong patient was on the operating table.

Addressing 160 delegates at the Orthopaedic Association's annual scientific conference in Christchurch yesterday surgeon Gary Hooper called for compulsory "time out" sessions before every operation to ensure the surgeon had the right patient, the right spot and the right procedure.

He said ACC figures showed 38 per cent of orthopaedic surgeons had reported at least one incident of wrong site surgery in their career - half through operating on the wrong side and 42 per cent for spinal procedures at the wrong level.

Mr Hooper said patients had their details checked four times between arriving at hospital and entering surgery, yet mistakes still happened.

In an audit of 10,330 operations in Christchurch last year, Mr Hooper said, three "near misses" were uncovered.

In two cases, the wrong patient was on the operating table after surgical lists were rescheduled.

Another 10 cases had mistakes in the paperwork meaning a blood transfusion would have been impossible. Mr Hooper said mistakes were usually blamed on the surgeon but could be due to many factors. In 8 per cent of cases the patient had provided the wrong information.

In one near miss, Mr Hooper said, the patient allowed the surgeon to mark the wrong arm with a pen before surgery because he thought the surgeon "was joking".

For the past 18 months all Christchurch surgeons held a "time out" session before every operation to pick up such mistakes, said Mr Hooper.

"The three near misses could have been disasters but they weren't."

Time outs involves the whole operating team including the surgeon, anaesthetist and nurses, pausing before surgery to recheck the patient's identity, the operation to be done, the correct site and any equipment needed.

Mr Hooper said time out sessions should be mandatory in all operating rooms.

American research has found wrong site surgery happened at a rate of between one in every 15,000 to 30,000 operations.

About one-third of incorrect operations were done on the wrong patient, usually one scheduled to have a different operation.

Nationally, ACC has had 28 claims for wrong site surgery in the 10 years to March 2003, accounting for 2 per cent of all medical errors.

Patients affected ranged in age from 15 to 87 and cost ACC $93,000. The average claim was $3700.

Error rates were similar in public and private hospitals.

- NZPA