The simple definition of a surgical error is a preventable mistake that occurs during the perioperative period that results in harm to the patient. In this context, it’s important to remember the perioperative period is not just the time the patient is in the actual operating room.
The perioperative period encompasses these three critical stages of the surgical process:
Another important point to remember is that surgical errors do not include acceptable known risks of an operation. Instead, they refer to avoidable mistakes. This includes such mistakes as performing the wrong procedure, operating on the wrong part of the body, leaving surgical instruments inside the patient, or making anesthesia errors.
Surgical mistakes such as these are a significant concern in healthcare because they can cause the patient to experience severe complications, a longer and/or more painful recovery, disability, or even death. On a broader level, surgical errors can lead to a loss of trust in medical providers, increased medical care costs, and a risk of medical malpractice lawsuits.
The potentially life-threatening consequences of surgical errors underscore the need for continuous education and vigilance among healthcare providers and medical professionals. In this article, we provide an overview of five types of surgical errors, highlighting lesser-known risk factors and advanced prevention strategies to help reduce incidences and improve surgical outcomes.
We wrote an entire blog covering emergency room errors in detail and with examples, read it here.
Wrong site surgery is when the surgeon operates on the wrong body part. Examples include operating on an incorrect organ or on the wrong side of the body, such as operating on the right arm instead of the left. It also includes operations at the incorrect level, such as the wrong spinal level.
Wrong site surgeries are one of the three major surgical errors comprising WSPEs—wrong site, wrong procedure, and wrong patient errors. Healthcare providers call WSPEs “never events” because they are serious, preventable errors that should never occur. WSPEs can permanently harm the patient, lead to additional surgeries, or in extreme cases, may cause death.
A study reported by the American College of Surgeons showed that in 2022 “wrong site surgery accounted for 6% of the 1,441 sentinel events reviewed by The Joint Commission.” To prevent wrong site surgery, the Joint Commission (the nation’s largest healthcare accrediting body) recommends surgical teams conduct these three steps:
Several types of anesthesia-related errors can occur during surgery. An overdose or underdose can happen when the anesthesiologist or nurse anesthetist incorrectly administers the local or general anesthesia or incorrectly calculates the dosage. This may cause the patient to experience pain or prolonged unconsciousness.
Administering the wrong type of anesthesia may lead to ineffective pain management or adverse reactions that can range from mild to severe. The patient may experience nausea and vomiting, allergic reactions, difficulty breathing, confusion, or low blood pressure. Delayed anesthesia may mean the patient experiences anxiety and unnecessary pain.
Preventing anesthesia errors starts before the patient enters the operating room. As part of the preoperative assessment, the surgical team should review the patient’s history and potential risk factors. The surgical team should maintain strict adherence to anesthesia-related protocols. This includes continuous monitoring of vital signs, double-checking of dosages, and observing postoperative recovery procedures.
Retained surgical items (RSIs) are items a surgical team unintentionally leaves in a patient’s body after an operation. Sponges, clamps, needles, gauze, and device fragments are examples of RSIs. A report by the Pennsylvania Patient Safety Authority estimates that 1 to 2 RSIs occur per 100,000 patient procedures.
RSIs may result in the patient experiencing surgical complications like pain and infection. Some cases lead to severe injury or death. Causes of RSIs include poor communication among the surgical team, lack of adherence to procedures, and inaccurate surgical counts.
Manual counting of surgical items is the most common form of RSI prevention. However, this method is prone to human error. For this reason, some hospitals now use new technologies like computer-assisted counting and radio frequency identification (RFID) tracking devices.
A patient may experience Surgically-Induced Neuropathic Pain (SNPP) because of compression, stretching, or direct trauma of the nerves during surgery. In addition to pain, patients experiencing SNPP often feel numb or weak in the impacted area. SNPP can also result in a permanent loss of function.
Many common scenarios exist wherein nerve damage can occur during surgery, such as:
Surgeons can minimize the risk of nerve damage by ensuring the patient is properly positioned and padded, which can prevent compression injuries. Surgical teams should participate in ongoing training on nerve anatomy and injury prevention. Preoperative planning can also play a crucial role in preventing nerve damage, along with using nerve monitoring technology during surgery.
According to the Cleveland Clinic, infections after surgery are not common, with only 1% to 3% of patients developing a surgical site infection (SSI). Still, when SSIs do occur, they can be painful, lead to disability, or even be life threatening.
Errors that occur in the operating room can dramatically increase the risk of post-operative infections. If the surgical team fails to follow proper sterile techniques, they could introduce bacteria and other pathogens that could cause an SSI.
Many protocols exist that surgical teams should follow to prevent infection, including:
Equally important is the careful monitoring of the patient post-surgery, which includes dressing changes and proper wound care. Health providers should look for infection signs like inflammation, redness, fever, or unusual discharge. By detecting infection early, the patient can receive quick treatment, which minimizes the risk of complications.
Read our blog answering the question What Are the Top 5 Medical Errors? including a detailed look at healthcare associated infections (HAIs).
Studies show that human factors—like fatigue, distraction, and miscommunication—substantially contribute to surgical errors. Fatigue can impair judgment and reaction times, distractions can cause concentration lapses, and miscommunication can result in incorrect procedures or dosages.
A study in the journal Surgery reported on the human factors that contributed to surgical errors over a 12-month period at a large surgical center. Of the 9,830 surgical procedures studied, major complications happened in 332 patients (3.4%).
In those patients with major complications, inattention to detail contributed to 29.3% of the errors, judgment mistakes contributed to 29.6% of the errors, and incomplete understanding contributed to 22.7% of the errors.
With such a high rate of human factors contributing to surgical errors, surgical teams should emphasize actions that promote effective team coordination. Rather than having one staff member in charge of making sure everyone follows protocols, fostering a culture of teamwork and clear communication can improve patient safety.
Hospital and healthcare management often face systemic problems that contribute to surgical errors. Without proper oversight and corrective action, these system-wide issues can leave patients at a higher risk of complications.
For example, understaffing results in overworked personnel, increasing the risk of fatigue-related errors. Failure to maintain equipment may lead to surgical disruption and direct patient harm. Inadequate protocols may leave room for inconsistencies and oversights in patient care. In these cases, it is up to management (along with surgical team leaders) to spearhead reform measures focusing on a strong safety culture.
Surgeons who have inadequate training and/or a lack of experience are at a higher risk for surgical errors. Less experienced surgeons—especially those still in training or early in their careers—tend to have higher surgical error rates than more experienced surgeons. As surgeons gain more experience and perform higher volumes of specific procedures, their error rates generally decrease.
A study published in the New England Journal of Medicine proves this point. The study found that for complex surgical procedures, as surgeons performed more operations, their complication rates dropped. The sharpest drops happened in the first 20 to 30 procedures, underscoring the importance of proper training and supervised experience for new surgeons.
No one strategy provides a failsafe method for preventing surgical errors. Instead, combining the following methods offers the most comprehensive approach to reducing surgical errors:
Surgical centers and hospitals around the world use the WHO Surgical Safety Checklist to help reduce surgical errors. The 19-item checklist has three sections: 1) before induction of anesthesia, 2) before skin incision, and 3) before the patient leaves the operating room. Each section contains critical questions the surgical team must refer to and answer during the perioperative period.
One study showed that hospitals that implemented the WHO Checklist had a reduction in surgical site infections from 6.2% to 3.4%. The death rate decreased from 1.5% to 0.8%. About 84% of staff involved thought the checklist improved communication and 78% believed it reduced errors.
By prioritizing clear, consistent communication, surgical teams can significantly reduce the risk of errors and improve patient outcomes. Techniques to improve teamwork and communication include:
Surgical team leads can play a vital role in fostering a communicative environment. They can model open communication techniques and encourage all team members to speak up about safety concerns.
New technologies—especially artificial intelligence (AI) and machine learning (ML)—show exciting potential for preventing surgical errors. These amazing technologies can analyze vast amounts of data to predict risks, provide real-time guidance, and enhance decision-making during surgeries.
For example, John Hopkins Medicine reports using a computer algorithm to assist surgeons in identifying the correct spinal level. The program (called “LevelCheck”) aims to reduce wrong site surgical errors by providing surgeons with immediate information to ensure they don’t operate on the wrong spinal segment.
By participating in continuous training, surgical teams can maintain and improve their skills. They can keep up with best practices, along with identifying and addressing skill gaps before they lead to surgical errors.
Simulation training allows teams to practice emergency scenarios or complex procedures in a safe environment. One study of hyper-realistic immersive simulations involved U.S. Navy and Army surgical teams practicing combat trauma care scenarios. The study found simulation training helped reduce patient resuscitation time and critical errors.
The World Health Organization (WHO) publishes safe surgery guidelines that emphasize the importance of establishing a robust safety culture for preventing surgical errors.
Key recommendations include:
One of the most shocking cases of surgical errors occurred at Rhode Island Hospital, the teaching hospital for Brown University. Hospital surgeons performed three wrong site brain surgeries within a single year. An investigation revealed these errors had two causes:
The hospital had to pay a fine of $150,000 and implement new safety measures, including camera systems in operating rooms to ensure compliance with safety checklists.
Another high-profile surgical error case involved comedian Dana Carvey. In 1998, Carvey underwent a double bypass operation, but the surgeon operated on the wrong artery. The surgeon misinterpreted Carvey’s angiogram results and failed to verify the correct surgical site. Carvey sued the surgeon in a $7.5 million medical malpractice lawsuit, and they settled in 2000.
The Mayo Clinic and six other U.S. health care systems implemented a surgical site infection program to reduce infections in colorectal surgery. The program helped avoid approximately 135 surgical site infections. One year after starting the SSI reduction program, the Mayo Clinic reported overall colorectal SSI rates dropped from 9.8% to 4.0%.
The successful program had the healthcare providers focus on implementing some amazingly simple interventions, such as:
In this article, we’ve explored five common surgical errors, their causes, and prevention strategies. We’ve also discussed how the combination of evidence-based protocols, team training, technology, and a strong safety culture can lead to significant reductions in surgical errors and improved patient outcomes.
But even with all these safety practices in place, surgical errors, and thus potentially medical malpractice claims, can still occur. As a physician, you’ll want to ensure your malpractice insurance policy helps you manage the risks of your profession.
Using its proprietary underwriting model, Indigo leverages robust data sets and artificial intelligence to quickly analyze thousands of data points. This enables us to provide individualized pricing to physicians in all medical specialties. Indigo rewards physicians that practice good medicine with bigger potential savings.
Image by Georgiy Datsenko from iStock.
