Trust Polarized by Misgivings

"I would not want the reader to go away with the view that surgery is unsafe. I think surgery is safer now than it's ever been. But it's also more complex. We have better clinical outcomes from surgery than we've ever had. We have fewer complications than we've had, but there's room for improvement." 
"One patient is identified for a particular procedure, something changes, the OR [operating room theatre] -- a multiple trauma comes to the hospital -- and things are all re-arranged, and sometimes things get out of sync. It's sometimes possible to get the wrong patient."
"This is happening to good surgeons. [With brain surgery] when complications do occur [for example], they can be serious."
Dr Gordon Wallace, managing director, safe medical care, Canadian Medical Protective Association

"Surgical procedures are complex and may carry significant risks for patients even in the best hands."
Canadian Medical Protective Association [CMPA] review and analysis

Many hospitals have introduced surgical safety checklists that should be followed before a single incision is made; in some provinces, they’re mandatory. Fotolia

A recently-released review of surgeries carried out in Canada through the years 2004-13, involving 1,583 cases of doctors accused of malpractise that were handled by the largest liability insurer for Canadian hospitals and their employees (Healthcare Insurance Reciprocal of Canada) lists communications breakdowns, "absent, sparse or illegible" documentation, and incidents where system safety checks were not followed, as factors helping to contribute to serious surgical misadventures.

The review states that over a million surgical procedures take place annually in Canada. Back in 2004 a Canadian study reached the conclusion that an estimated 70,000 instances of preventable medical errors take place yearly in hospitals, over half of them taking place during surgery. In the United States by contrast, medical error is now recognized as the third-largest cause of death, right behind cancer and heart disease. An American study newly published, estimates that 250,000 Americans die annually as a result of medical care "gone awry".

Researchers from the Johns Hopkins University School of Medicine in Baltimore reporting in the British Medical Journal stated that "Medical error leading to patient death is under-recognized in many other countries, including the United Kingdom and Canada". As though the horrendous toll seen in the United States can be minimized by drawing in similar incidents taking place elsewhere in the developed world where medical science has accelerated its understanding of health issues and formulated best practise surgical procedures as a pioneering force for prolonging human life.

The Canadian analytical report concluded that one-third of the cases taking place in Canada resulted in severe harm to patients, ranging from devastating injuries such as major organ damage, or paralysis, to the hastening of death. Most of these surgeries involved non-cancer, non-trauma surgery where the average patient age was 49, and 76 percent were in relatively good health pre-surgery. An earlier investigation had revealed that a mere fraction of errors are reported by staff on an internal basis. Pointing to an obvious universal propensity to shield the medical community from controversy.

Experts reviewing the cases found fault with the care provided in half of them. The top five sites for surgical error were found to be the uterus, gallbladder, colon, chest or abdomen muscles and breast. Patient harm ranged from death to lacerations, punctures, infections, hemorrhage and burns. Cases involved sponges, rolls or other instruments left in patients, or "wrong surgery", where the wrong patient, the wrong procedure or the wrong body part was involved for 12 percent and 18 percent respectively of CMPA and Healthcare Insurance Reciprocal of Canada cases.

Hospitals are well aware of these unfortunate incidents of surgeries leading to "mishaps", as are their staff. In many hospitals surgical safety checklists have been developed, meant to represent a safety protocol to be followed before surgery is initiated. These checklists have become mandatory in some provinces. First, the patient's name and procedure is confirmed. If an eye, or an organ is to be operated on on the left, then the left side is marked on the patient. Surgical teams are expected to perform rigorous counts to ensure that sponges, needles and instruments entering the operating room are all accounted for.

Handout An x-ray shows a surgical instrument that was left inside a patient's body after surgery. Research suggests that about 70,000 patients a year experience preventable, serious injury as a result of treatments in Canada.

Wrong-side surgery happens on occasion where the wrong organ is removed. Instances of "retained foreign bodies", which could be towels, packing, needles and sponges left inside a patient in error can occur when prolonged surgeries take place, or when complications set in, like heavy bleeding requiring emergency reaction, according to Dr. Wallace. Neurosurgeons and orthopedic surgeons were identified as the most likely to be involved in surgical incidents; distractions of one kind or another can occur, and people being human, make errors in judgement and process.

"Patient safety incident" terminology

Medical condition
Most unexpected poor clinical outcomes result from the advancement of a medical condition (i.e. the disease process).
Harmful incident from healthcare delivery
Harm results from the care or services provided to the patient.
Recognized risks inherent to investigations and treatments
Most investigations and treatments have inherent risks. Certain complications, adverse reactions or side-effects may occur and are independent of who is providing the care.
Harmful patient safety incident
A patient safety incident that resulted in harm to the patient.
No-harm incident
A patient safety incident that reached a patient but no discernable harm resulted.
Near miss
A patient safety incident that did not reach the patient and therefore no harm results. These have also been called "close calls" or "good catches."
Reportable circumstance
A situation in which there was significant potential for harm, but no patient safety incident occurred. (Specific patient not involved)
The Canadian Medical Protective Association