Most mistakes in an operating room are technical errors made by experienced surgeons during routine procedures, a recent study reports.
Harvard University researchers, working under the aegis of the fed-eral Agency for Healthcare Research and Quality, found 133 cases of technical errors among 444 randomly chosen malpractice claims.
“Almost three-fourths [73%] of those errors involved fully trained and experienced surgeons operating within their area of expertise, and 84% occurred in routine operations, for which advanced expertise be-yond a standard training program was not required or expected,” they wrote in Annals of Surgery (2007;246:705-711).
Sixty-five percent of the errors were either fatal or caused permanent disability. Most mistakes occurred in cases complicated by unusual anatomy (25%), a repeated procedure (20%), or urgent, emergency situations. General or GI surgery was the most common specialty (31%), followed by spinal (15%), and gynecologic (12%). Urologic operations accounted for 4% of the claims.
The researchers divided technical errors into two categories: errors of execution and errors of judgment, such as failing to recognize a complication or choosing the wrong technique. A majority of claims (65%) involved manual mishaps only, and more than a quarter (26%) involved both manual and judgment mistakes.
Common execution errors included incidental visceral injury (34%); a breakdown of operative repair or failure to relieve the disease (16%); hemorrhage (16%); and peripheral nerve damage (14%).
Most cases involved attending surgeons operating alone (69%) or with residents or fellows (27%). As a result, the researchers note, traditional safety remedies like more training or closer supervision would probably be ineffective. Instead, they recommend focusing on “strategies to improve decision-making, operative planning, and team performance for common operations, particularly under high-risk circumstances.”