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 federal Agency for Healthcare Research and Quality, found 133 cases of technical errors among 444 randomly chosen malpractice claims.

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“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 beyond 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.”