SURGICAL ERRORS IN ENGLAND AND WALES – HOW COMMON ARE THEY AND ARE ORTHOPAEDIC SURGEONS REALLY THE WORST?

Abstract

Background: Procedures performed at the incorrect anatomical site are perceived as rare events. However, they can be devastating for patients and doctors. In 2007, the Chief Medical Officer for England highlighted surgical site errors as an area of concern. Evidence from the UK and North America suggests that these events are more common than we think. We present our findings on the rates of surgical errors in England and Wales.

Methods: We obtained information from the National Patient Safety Agency (NPSA) and the NHS Litigation Authority (NHSLA) detailing reported cases of surgical error in England and Wales in the time period 1995–2007. This information was evaluated in conjunction with data detailing the total number of operations performed in England and Wales for the same time periods.

Results: Since 1995 there have been 292 cases of errors recorded on the NHSLA database. Orthopaedic surgery was the worst offending speciality with 87 cases (29.8%). There were 49 cases (16.8%) in dental surgery and 40 cases (13.7%) in general surgery. The most commonly affected sub-specialty area of orthopaedic surgery was the hand (21 cases), followed by foot and ankle (18 cases) and spine (16 cases). The total cost of the cases which have been settled was £2,252,752.58. For the year 2006–2007 the risk of an event in orthopaedic surgery was calculated to be 1 in 105,712 cases. The risk in general surgery and obstetrics and gynaecology during this period was 1 in 353,511 and 1 in 133,371 respectively.

Discussion: Orthopaedic procedures featured more commonly on the NHSLA database than any other specialty. Rates were also higher after adjustment for case load. We would like to draw attention to policies such as the WHO surgical safety checklist which aim to reduce the occurrence of such adverse incidents.