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| How Common is Wrong-site Surgery?
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The incidence of wrong-site surgery is more prevalent than healthcare professionals appreciate, according to a study published in the September issue of Archives of Surgery. Researchers examined the National Practitioner Data Bank, the Florida Code 15 mandatory reporting system, the American Society of Anesthesiologists' Closed Claims Project database and a Web-based collection system to estimate that 1,300 to 2,700 wrong-site surgeries occur every year.
The study's authors believe the discrepancy between the perception and reality of wrong-site surgery occurrence is based in part on its lack of coverage in medical literature, noting that past research shows physician reporting has ranged from 5 percent to 50 percent of adverse events.
"Practitioners and institutions are fearful of liability and punitive actions surrounding errors and near-misses," says the study's co-author, Samuel Seiden, MD. "The paradigm in healthcare is not such that errors should be reported so that we can learn from them, but rather, errors should be concealed to minimize risk."
Dr. Seiden suggests the prevention of wrong-site surgeries will likely arise from a combination of increased awareness, teamwork, reporting of adverse events and near misses and technological innovation.
Despite precautions, surgical mishaps remain an unfortunate reality. "Wrong-site surgeries are caused by obviously intelligent healthcare professionals who are trying to do their best," says Dr. Seiden. "Most often, practitioners have told us, 'I never thought this would happen to me — until it did.'"
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| OIG to Address Cataract Surgery Payments, SUD Reuse
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The incidence of wrong-site surgery is more prevalent than healthcare professionals appreciate, according to a study published in the September issue of Archives of Surgery. Researchers examined the National Practitioner Data Bank, the Florida Code 15 mandatory reporting system, the American Society of Anesthesiologists' Closed Claims Project database and a Web-based collection system to estimate that 1,300 to 2,700 wrong-site surgeries occur every year.
The study's authors believe the discrepancy between the perception and reality of wrong-site surgery occurrence is based in part on its lack of coverage in medical literature, noting that past research shows physician reporting has ranged from 5 percent to 50 percent of adverse events.
"Practitioners and institutions are fearful of liability and punitive actions surrounding errors and near-misses," says the study's co-author, Samuel Seiden, MD. "The paradigm in healthcare is not such that errors should be reported so that we can learn from them, but rather, errors should be concealed to minimize risk."
Dr. Seiden suggests the prevention of wrong-site surgeries will likely arise from a combination of increased awareness, teamwork, reporting of adverse events and near misses and technological innovation.
Despite precautions, surgical mishaps remain an unfortunate reality. "Wrong-site surgeries are caused by obviously intelligent healthcare professionals who are trying to do their best," says Dr. Seiden. "Most often, practitioners have told us, 'I never thought this would happen to me — until it did.'"
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| CRNA Accused of Murder
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A North Carolina woman who used to work as a nurse anesthetist at a Charlotte plastic surgery clinic has been charged with first-degree murder in the April 2001 drug overdose death of a patient who'd been her high school classmate 30 years before.
Sally Jordan Hill, 50, is accused of administering a large and fatal dose of fentanyl to facelift patient Sandra Joyner; of turning off an alarm that would have alerted staff to Ms. Joyner's breathing difficulties during recovery; and of failing to immediately call for help when Ms. Joyner's condition deteriorated, investigators testified at a bond hearing.
Investigators say they believe Ms. Hill held a grudge against Ms. Joyner that dated back to the early 1970s at Charlotte's Olympic High School and that involved a dispute over a boyfriend.
Ms. Joyner died five days after the procedure, performed at the Center for Cosmetic and Plastic Surgery on April 10, 2001. Medical examiners ruled the death an accidental poisoning, likely caused by fentanyl, and the case was closed. While North Carolina's medical and nursing boards investigated and determined that Ms. Hill had made serious mistakes, neither board accused her of intentional wrongdoing. A tip communicated to police last month led to her arrest.
Ms. Hill has told investigators that she only gave Ms. Joyner a total of 7ccs of fentanyl: 5ccs in the OR and 2ccs in the recovery room. "This was an unfortunate medical occurrence," says Ms. Hill's lawyer, Susan Weigand.
But police say they believe that 5ccs of fentanyl that were discovered missing from the surgery center were also administered to Ms. Joyner. Ms. Hill, they say, has admitted to altering a medication log.
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| News and Notes |
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SURGEONS WHO ARE BOARD CERTIFIED by the American Board of Cosmetic Surgery may now display their credentials just as those who practice other specialties recognized by the American Board of Medical Specialties do. Cosmetic practitioners were granted equivalency status by a California Supreme court judge who overturned a state Medical Board decision on the matter and ruled that the ABCS's certification requirements meet or exceed the training requirements maintained by the ABMS.
DUODENAL SWITCH PROVIDES SUPERIOR WEIGHT LOSS among super-obese patients as compared to Roux-en-Y gastric bypass, suggests a study published in the October issue of Annals of Surgery. Researchers studied a total of 350 super-obese patients who underwent weight-loss surgery (198 underwent duodenal switch; 152 underwent Roux-en-Y). The resulting percentages of excess weight loss, total weight loss and decreased BMI were statistically greater among the duodenal switch patients. Additionally, the likelihood of successful weight loss after surgery was significantly greater in patients who'd undergone the duodenal switch.
A MESH CLOSURE FOR OPEN GASTRIC BYPASS SURGERY may help prevent post-surgical hernia complications, say researchers. In a study published online by the British Journal of Surgery, physicians at Barlicki Hospital in Lodz, Poland, observed 74 patients undergoing Roux-en-Y gastric bypass procedures. Noting that about one-fourth of such patients suffer incisional hernias following the surgery, the researchers closed 36 of the patients' incisions with polypropylene mesh and the other 38 with standard sutures. While eight of the sutured patients developed post-op hernias in the six months following surgery, none of the mesh patients did. The mesh did not affect patients' length of stay or the overall cost of their procedures, researchers note. |
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