Articles Posted in Surgical Error

At some point in life, nearly every American will undergo surgery. Some of these surgeries will be elective, meaning surgery is scheduled in advance because it does not involve a true medical emergency. Others will be emergent where surgery is often necessary for the patient to survive. If surgery is urgent, there is a good chance it will involve the abdomen and post-operative care will be necessary.

Abdominal procedures comprise of a significant percentage of emergency procedures in which the patient dies shortly thereafter. Examples of abdominal emergency procedures include bowel resections, partial colon resections, and gallbladder removal. Complications from these surgeries can involve bleeding and infections. According to one study from the JAMA Surgery, roughly 15 percent of all patients undergoing GI tract surgery will be readmitted to the hospital within one month of surgery due to a post-operative complication. Other abdominal surgery cases will involve post-operative complications that occur before the patient every leaves the hospital and are not directly caused by the surgery itself.

Whether an abdominal surgery complication or post-operative care is due to medical malpractice or simply an accepted risk of the procedures can be a complicated question. One of the first inquiries is whether the surgery was medically indicated. Another is whether the surgery was properly performed. Even if the surgery was indicated and properly performed, the medical staff may not have properly responded to signs and symptoms of a complication such as infection or bleeding. Still other cases may involve complications related post-operative care in the hospital, meaning the complication was not directly caused by any surgical error. For example, many medical experts believe Artist, Andy Warhol’s death, was caused by preventable post-operative care when a nurse allegedly pumped way too much fluid into him after a routine gallbladder procedure.

Going through a surgical procedure can be a nerve-wracking event. As a patient, you put your trust in your surgeon’s experience and skill to provide you with excellent care. But even in the best situations, complications can occur–either during the operation or following the procedure, sometimes leading to medical malpractice lawsuits. While doctors and patients alike hope to avoid any kind of surgical errors, hospitals have been shown to gain financially from post-surgical complications.

A new study of a group of southern hospitals reveals that the “contribution margin,” or profit per patient, is higher when patients have one or more complications following surgery. The study’s senior author, Dr. Atul Gawande from Brigham and Women’s Hospital and the Harvard School of Public Health, emphasizes that this information is not to suggest that hospitals are counting on surgical complications to bring in more money. The real problem lies in the way hospitals are paid for patients covered by Medicare or private insurance versus those who pay out-of-pocket or are covered by Medicaid.

Researchers evaluated the hospital group’s financial information over the course of caring for over 34,000 patients in 2010. Close to 2000 of those patients experienced one or more complications following surgery. Privately insured patients who experienced no complications netted the hospitals an average of $17,000 of profit; for those with one or more complications the profit jumped to an average of $56,000. Comparatively, hospitals lost money in all surgeries involving Medicare patients and patients paying out-of-pocket, regardless of complications.

Very few of us have jobs in which there are no distractions. When distractions occur, they often impact our ability to perform our job effectively. According to a recent study, doctors are also not immune to the adverse impacts that distractions have on job performance. Specifically, the study found that distractions during surgery significantly increased the rate of surgical errors by residents.

As reported in the Archives of Surgery, participants of the study consisted of 18 general surgery residents from Oregon Health & Science University of Portland. Each of the 18 general surgery residents was required to perform a simulated laparoscopic cholecystectomy, which involves removing the gallbladder, with and without distractions. The commonly cited distractions used during surgery were expected movements seen by the observer, a ringing cell phone answered by the observer, conversations between the observer and a third party unrelated to surgery, noise from a dropped metal tray, and a question about a topic unrelated to the surgery.

Out of 18 surgeries, distracted residents made eight medical mistakes. Residents who were not distracted made only one surgical error out of 18 operations. The authors of the study concluded that realistic operating room distractions and interruptions greatly increased the likelihood of surgical mistakes–at least for novice surgeons. This study is important because it shows unnecessary distractions and interruptions significantly increase the rate of adverse patient outcomes and, by extension, the rate of avoidable medical malpractice lawsuits.