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Initial Evidence Reduced Levels of Wrong Sided Surgery PDF Print E-mail

Brendan D. Lewis, M.D., FRCSC
Cornerbrook, NF

The Canadian Orthopaedic Association’s (COA) attempts to eliminate Wrong sided surgery, wrong patient, and wrong level spinal surgery with the introduction of the position papers on “Wrong Sided Surgery in Orthopaedics” and “Wrong Level Spinal Surgery” continues to show steady improvement.  

Recent correspondence from Dr. William J. Beilby, Managing Director of the Department of Research and Education of the Canadian Medical Protective Association (CMPA) has demonstrated that there are some encouraging results. Dr. Beilby explained the collection of data when he provided his information.

Dr. Beilby indicated, particularly for the more recent cases, recognizing there is a delay from the time an incident occurs to when a lawsuit is brought; counting the number of lawsuits may be somewhat misleading and underestimates the number of incidents. Keeping this in mind, they also extracted cases that were labeled as threats. He pointed out that while these were not lawsuits, they were judged to be of high risk to become lawsuits, and would more accurately reflect the current state of affairs.

Dr. Beilby had provided a graph showing the absolute number of cases in each of the years from 1987 to 2000. The resulting “straight line” illustrates the trend over time and a decrease in the number of cases.

Overall, there has been a reduction from approximately 13 cases per year to five cases per year.

The most common error involves the incorrect knee. Dr. Beilby indicated that from the information available, all but one of these did not have the site marked. In the one case that was marked, the incorrect side was prepped and draped and the procedure conducted in spite of the fact that the mark was not visible in the operative field.

There were two cases involving elbow surgery performed on the correct arm but incorrect location as a result of a mix-up between medial and lateral.

In two cases involving tendon sheath surgery in the hand, the incorrect site was operated upon.

It is important for the surgeon to review the chart and visit the patient before surgery to mark the limb or location with his or her INITIALS. This is especially critical when operating on the medial or lateral side (for example, the elbow) and digits on the hands and feet.

The Canadian Orthopaedic Association wishes to thank Dr. Beilby and the CMPA for analyzing the data in order to provide us with these results. The COA continues to work with the CMPA to identify areas of risk that require ongoing doctor education.

The present results clearly show that the initiative of operating through your INITIALS works!!