Guarding against wrong-side surgery

By MICHAEL WOODS
Toledo Blade
August 07, 2002
- Wrong-side surgery is an operation done by mistake on the healthy side of the body, rather than the diseased side.

Amid nationwide concern over medical errors, wrong-side surgery incidents often get lots of attention.

That's because wrong-side surgery is such an obvious mistake.

A Florida brain surgeon earlier this year started cutting into one side of a patient's head before realizing that he really meant to do the other side. A Michigan jury in April awarded $500,000 to a boy whose urologist twice operated on the wrong kidney. Patients undergo surgery to have a painful right knee joint replaced, and wake up with bandages on the left knee.

Other incidents have involved operations on the wrong eye, hip joint, side of the spine, and even amputations of the wrong limb.

Wrong-side surgery often is a worry for the millions of people who undergo surgical operations each year.

It does top a list of 27 serious, preventable medical errors prepared by the National Quality Forum, a Washington-based group that promotes a national strategy for assuring the quality of health care.

Dr. Kenneth Kaizer, the group's president, argues that wrong-side surgery occurs more often than many people believe. By all accounts, however, wrong-side surgery is very rare.

The Joint Commission on Accreditation of Healthcare Organizations (JCAHC) last December documented about 150 reported incidents since 1996. They included mainly arms, legs and paired organs like kidneys, eyes and breasts.

Not included in the figure, of course, were near-misses in which the surgeon started operating on the wrong side, but caught the mistake. Nor does it include incidents that were hushed-up and never reported.

Even so, wrong-side operations occur in only a tiny fraction of the 70 million surgeries done annually in the United States. They're a small part of a much wider problem in which patients get the wrong drug or other treatment.

A 1999 report from the Institute of Medicine (IOM) concluded that medical errors cause between 44,000 and 98,000 deaths in U.S. hospitals every year. IOM is part of the National Academy of Sciences, which advises the federal government on science.

Critics have claimed that the report exaggerated the number of deaths. But it remains one of the most comprehensive ever done on the topic.

Medical organizations have launched a major effort to make wrong-side surgery rarer.

National, state and local medical organizations are putting the tolerance level at zero, since wrong-side errors are 100 percent preventable.

Organizations like JCAHC, which accredits or certifies hospitals, and the American Academy of Orthopaedic Surgeons (AAOS), have been trying to enlist patients in the battle against wrong-side surgery.

JCAHC, for instance, issued an alert about wrong-side surgery to medical personnel in the 1990s. When that failed to have the desired impact, JCAHC followed up late last year with an alert to patients.

What should patients do before surgery that could involve a wrong-side error?
AAOS, JCAHC and other organizations suggest a simple routine that many surgeons already use:

- Get the surgeon's autograph.

Watch and confirm as the surgeon writes his initials with a permanent or indelible marking pen on the surgical site. The marks should be clear and unmistakable. If the surgeon doesn't suggest the autograph, patients should request it. The surgery then should be done through or near the autograph.

- Spinal surgery done at the wrong site also can be prevented with an X-ray that marks the exact spot in the spinal column where surgery is needed.

- Patients also can help by expressing concerns about wrong-side surgery to operating-room personnel.

(For news and information about Toledo visit http://www.toledoblade.com/. E-mail mwoods(at)nationalpress.com. Distributed by Scripps Howard News Service.)