Posted by Bill Sandweg on 06 December 2021.
Wrong site surgeries are in the news again. Wrong site surgery occurs when a surgeon operates on a part of the body that was not intended to be the target of the surgery. While most cases of wrong site surgery involve operating on the wrong side of the body – think left knee instead of right knee or right eye instead of left eye – there are other forms, such as where a spine surgeon operates on the wrong level of the spine. Whether they are in the news or not, wrong site surgeries are a vexing and continuing problem that just keeps happening over and over again.
Wrong site surgeries don’t happen very often. It is estimated that perhaps only one in 100,000 surgeries is performed on the wrong site. While that is not a very high rate, when coupled with the fact that there are millions of surgeries performed each year in the United States, that means there are hundreds of wrong site surgeries every year.
Wrong site surgeries are never good but many are devastating. They are particularly bad when the surgery is being done to remove a cancerous organ and leave behind its non-cancerous match. For example, there is a cancer in the left eye and the surgeon removes the good right eye. When the surgeon goes back and removes the cancerous left eye, as he must, the patient will be blind. Pretty much the same thing happens when the wrong kidney is removed. After the second operation removes the bad kidney that should have been taken in the first place, the patient will need lifelong dialysis. Under the best of circumstances, the result of an operation on the wrong site is an unnecessary surgery in which the surgeon recognizes the mistake before any irreversible damage is done.
Hospitals have developed procedures intended to stop wrong site surgeries. They usually involve some sort of “time out” to be taken by the operating room staff. During the time out, the staff, including the surgeon, is to make sure they have the correct patient, that they are doing the correct surgery on the patient and that the surgery is being done on the correct body part. The time out is a good idea that just doesn’t seem to be working as intended. One of the reasons it doesn’t work as well as it should is that surgeons sometimes refuse to participate in the time out.
In addition to hospitals establishing procedures intended to prevent wrong site surgeries, the Joint Commission, a non-profit organization that accredits health care institutions and sets standards, has recommended labeling the correct site for the intended surgery, when there is a possibility of left-right confusion. In a recent article in the Washington Post, Dr. David Perlow, an Atlanta urologist, has suggested that this recommendation is faulty and misguided. Dr. Perlow makes a lot of sense. He says that, rather than labeling the correct site, the surgical team should label the wrong site. If the surgeon is distracted, she or he may fail to notice that there is no “correct” label on the operative site. If the wrong site has been prepared for the surgery, the “correct” label may be covered by the surgical drapes that expose only the operative site. On the other hand, the “wrong” label will be exposed after draping and is much less likely to be missed or ignored.
Regardless of what the hospital decides to do about labeling, you can do your own labeling. You can take a marker and mark “wrong” or “no” or “stop” on the incorrect site. I did that when I had my left hip replaced about ten years ago. I don’t know that it made any difference, but the doctor operated on the correct hip. Nothing is guaranteed in life but this precaution may save you a lot of pain and grief.