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INTRODUCTION

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  • Technical errors can occur in surgical practice

  • The best way to reduce technical errors is prevention

  • Prevention of errors is important to reduce surgical morbidity and mortality

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STATE OF THE ART

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The Institute of Medicine defines error as “the failure of a planned action to be completed as intended (ie, error of execution) or the use of a wrong plan to achieve an aim (ie, error of planning).” According to a 1999 Institute of Medicine report, errors in health care are the eighth leading cause of death in the United States and account for up to 100,000 deaths annually. In particular, technical errors, which include errors of judgment, lack of knowledge, and manual errors, can lead to surgical adverse events.

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In surgery, highly invasive procedures, technical difficulties, and patients’ comorbidities are all factors contributing to the risky condition of surgical practice; in fact, between one-half and two-thirds of hospital adverse events are attributable to surgical care. Gawande et al examined 15,000 patient records and found that 66% of all adverse events are surgical and that 54% of these are preventable.1 If it is true that every intervention in medical practice carries a certain level of risk, even the simplest surgical procedure has the potential to develop into an adverse event: there are thousands of maneuvers in a routinely performed operation and each of these carries the opportunity of an adverse event.

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All these issues have generated a broad interest in the prevention of adverse events in health care. Every single surgeon should know what to expect when performing a procedure, what to do to prevent the occurrence of potential problems and, of course, how to minimize the adverse event to reduce the negative effects.

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Regenbogen et al reported that attending surgeons are responsible for 69% of surgical errors, with another 27% involving both attending surgeons and trainees.2 Only 4% of errors are attributed to residents and fellows alone. The most common types of operations associated with errors are general or gastrointestinal surgery (31%), spine surgery (15%), gynecologic surgery (12%), and nonspine orthopaedic surgery (9%). Ninety-one percent of the technical errors involve manual error and 35% involve judgment or knowledge error. About 65% of technical errors involve manual error only, while 27% involve both manual and judgment or knowledge components. Few involve solely knowledge or judgment errors (9%). The most common specific errors are incidental visceral injury (34%), the breakdown of operative repair or failure to relieve the disease (16%), hemorrhage (16%), and peripheral nerve injury (14%). Retained surgical equipment accounts for 3% of errors. Errors of judgment or knowledge include delay or error in intraoperative diagnosis or management (16%), incorrect choice of procedure or technique (9%), and wrong operative site (7%). A minority of technical errors involve index operations (16%), inexperienced surgeons (8%), surgeons operating outside their area of expertise (5%), or unexpected events ...

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