"Wrong-site" surgery appears to be rare

NEW YORK, Apr 25 (Reuters) It's a patient's worst nightmare -- to wake up from surgery to find that the surgeon has operated on the wrong organ or limb. It happens, but thankfully not often, according to a new report.

The study also indicates that surgical ''site-verification'' procedures designed to prevent so-called ''wrong-site'' surgery are not always effective.

Wrong-site surgery includes procedures performed on the wrong side of the body, the wrong body part, the wrong lesion or growth, such as moles on the skin, the wrong vertebra of the spine, or even the wrong patient.

''We learned that fortunately this kind of mistake is very rare and only occurs one time in 113,000 operations,'' Dr Mary R Kwaan from Brigham and Women's Hospital in Boston told Reuters Health.

To be exact, there were 40 cases of wrong-site surgery among a total of 2,826,367 operations performed in 30 Massachusetts hospitals between 1985 and 2004. The investigators excluded cases involving the wrong spinal vertebra, leaving 25 non-spine wrong-site operations, Kwaan and her colleagues report in the Archives of Surgery.

Medical records were available for 13 of the non-spine cases, and showed that one patient suffered a significant permanent injury, two suffered major temporary injuries and 10 suffered minor temporary injuries.

When the researchers dug deeper into these 13 of cases, they found that implementation of proper surgical procedures would have prevented only eight of these mistakes (62 per cent).

Hospitals are required by the Joint Commission on Accreditation of Healthcare Organisations, the hospital accrediting body, to verify the site and patient before surgery; mark the surgical site on the patient; and take a ''time out'' in the operating room before starting the procedure to review the checklist.

''Patients should be aware that all hospitals are required to have confirmation of the site and/or side of surgery on the day of surgery,'' Kwaan told Reuters Health.

''They can help facilitate this process of 'double-checking' by understanding what operation they are going to have. If they are confused, they should ask their doctor to clarify it with them - even that very morning of surgery,'' Kwaan said.

Patients are always asked to sign a consent form, which describes the planned procedure, at some point after the decision is made for surgery. ''They need to be able to understand the description of the procedure, including what exact part of the body is involved,'' Kwaan said.

Still, ''No protocol will prevent all cases,'' she and her associates write. ''Therefore, it will ultimately remain the surgeon's responsibility to ensure the correct site of operation in every case.'' REUTERS SI KN0959