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INTRODUCTION

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  • There are several valuable benefits of accurate preoperative planning including improved understanding of the procedure, communication of logistics and equipment needs, elimination of avoidable delays for equipment, and improved outcomes

  • A preoperative plan includes a surgical tactic, or step by step plan for the operation that allows the surgeon to think through the operation which can improve operative efficiency and identify unanticipated problems

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Preoperative planning can prevent intraoperative delays, confusion, and errors, leading to improved patient outcomes. Thinking through the sequential steps of an operation allows a surgeon to identify possible unanticipated problems and to develop contingency plans for achieving a successful outcome.

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BACKGROUND

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No surgeon goes to the operating room planning to fail, but many surgeons go to the operating room failing to plan. Preparation of a carefully thought-out preoperative plan offers many advantages for the surgeon, the operating room team, and the patient. Planning provides several benefits for the surgeon, including decreased stress during operative cases that go smoother and faster. The operating room team will be better prepared with all necessary equipment, and is more likely to view the surgeon as a competent and dependable surgeon with whom they enjoy working. The direct benefits of this preparation for the patient are improved outcomes and increased safety.

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The value of preoperative planning has long been recognized in orthopedic surgery, but it has become increasingly important as the technical complexity of procedures and equipment has expanded. While uniformly believed to be beneficial, the actual practice of preoperative planning is less than universal. In a survey assessing the perceived importance of preoperative planning, 94% of 34 consultants and 100% of 25 trainees considered it to be important in trauma cases, but only 50% of consultants and 48% of trainees reported that they routinely performed preoperative planning of their trauma cases.1

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PREOPERATIVE PLANNING

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As a surgeon’s experience increases, preoperative planning tends to become less formal, especially for lower complexity cases. While every operative case does not require the same type of detailed plan, every operation will benefit from some sort of plan. One of the most important aspects of preoperative planning is the advance stepwise thought process that is essentially a dress rehearsal of the operation. This cognitive part of the process is often the most important part of the planning process.

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A preoperative plan is also helpful in communicating with the operating room team the surgeon’s plans and the team members’ necessary roles. In addition to the required instruments and implants, it is also helpful to identify which additional items might be needed and should be kept on standby. For example, if prior hardware needs to be removed, it may be necessary to have broken screw removal instruments available if you encounter difficulty with the planned hardware removal. Identifying the necessary equipment is especially important for surgeons who ...

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