The following are the top five mistakes hospitals and doctors make during surgery in Virginia:
- Failing to prevent blood clots. It is not uncommon for a patient to develop a deep vein thrombosis (DVT) subsequent to surgery. A DVT is a condition where a blood clot (thrombus) forms in a vein, most frequently in the deep veins of the legs, thighs, and pelvis. A DVT may not initially cause significant symptoms (clinically silent) but can lead to a life-threatening pulmonary embolus when the blood clot travels to lungs. A DVT can lead to long term problems with phlebitis and puts a patient at risk for recurrent clots. Therefore, surgeons should order prophylactic medications (like low dose heparin) to reduce the risk of developing a post-operative DVT. Intermittent compression devices (sleeves and stockings) have also been found to reduce the likelihood of clots developing in surgical patients’ arms and legs.
- Failing to convert a laparoscopic gallbladder surgery to an open surgery. Thousands upon thousands of gallbladders are surgically removed every year in the United States via this minimally invasive surgical technique. Laparoscopic gallbladder surgery (cholecystectomy) removes the gallbladder and gallstones through several small incisions in the abdomen. The surgeon inflates the abdomen with air or carbon dioxide in order to see inside the abdomen. Next, the surgeon inserts a lighted scope attached to a video camera (laparoscope) into one incision near the belly button. The surgeon then uses a video monitor as a guide while inserting surgical instruments into the other incisions to remove the gallbladder. Problems arise, however, when the surgeon cannot obtain adequate visualization of structures and organs in the operative field inside the abdomen. Poor visualization can be caused by the presence of dense adhesions from previous abdominal surgery or from severe inflammation due to acute cholecystitis. In this situation, the surgeon should convert the procedure to an “open surgery” in order to better visualize the surgical field and avoid devastating injuries to the biliary tree.
- Failing to perform the right procedure on the right patient. It is a sad but true statement that on far too many occasions the wrong procedure is performed on the patient or the correct procedure is performed on the wrong patient. How could this happen? Easy. Operating rooms are busy places and surgeons often move from surgery suite to surgery suite performing one surgery after another in a busy operating room. “Wrong site surgery” (for example operating on the right knee when the injury was to the left knee) has become a big problem for surgeons and hospitals. Even the Centers for Medicare and Medicaid Services (CMS) issued a policy change effective January of 2009 that it would no longer pay hospitals and surgeons for these types of mistakes.
- Problems with anesthesiologists or nurse anesthetists. These professionals are present for all surgeries. Their job is to make sure the patient is properly positioned for the surgery and to administer safe and appropriate anesthesia to the patient. The types of anesthesia include local, regional, epidural/spinal, and general. The most important job for the anesthesiologist/anesthetist is to make sure the patient’s airway is clear and the patient is receiving sufficient oxygen. To this end, many patients are intubated with a “breathing tube” during surgery and it is the job of the anesthesiologist/anesthetist to monitor the patients’ vital signs (heart rate, respiratory rate, blood oxygen saturation) to make sure the patient is getting sufficient oxygen. Death or injury to the brain can result from inadequate oxygen during surgery.
- Failing to react to post-operative problems. The scenario unfolds like this. A patient undergoes a surgical procedure (gallbladder or appendix removal, repair of a torn ACL in the knee, or the removal of a benign cyst, etc.,) and everything went great. No complications or problems were encountered during the surgical procedure and the patient is told they will be discharged home in a day or two. On the first post-operative day, the patient starts complaining of more pain than one would anticipate. The surgeon does nothing. On post-operative day two, the patient begins to run a fever and show signs of infection. The surgeon does nothing. On post-operative day three, the laboratory reports the patient’s blood count is low. Again, the surgeon does nothing and fails to recognize that, unbeknownst to her/him, the bowel was cut during original surgery or a vein in the operative field was not adequately closed and the patient has been bleeding internally and an infection has now set in. Surgeons often think their job is complete after the patient leaves the Operating Room. Nothing could be further from the truth. If the patient is not doing as well as expected after the surgery, the surgeon must determine the cause/source of the problems and take the patient back to the operating room to repair the problem if necessary.