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No surgeon in the world would get up in the morning with the intent of creating a surgical complication. Beyond dispute, surgeons and patients are intrinsically aligned in their intent of avoiding complications and adverse events. In spite of this unwavering bond, surgeons have traditionally fallen short of rising up as credible leaders and stewards for patient safety. In the wake of this chronic negligence, current statistics elevated medical errors to the third leading cause of death in the United States, following cardiovascular disease and cancer. Strikingly, in the 21st century, we still have to come to terms with the absurd reality that it is significantly safer to board a commercial airplane, a spacecraft, or a nuclear submarine, than to be admitted to a US hospital. The evidence-based estimate of more than 400,000 preventable annual deaths occurring in US hospitals every year (Journal of Patient Safety 2013, 9:122-8) is analogous to 3 jumbo jets crashing each day, all year long, in perpetuity. In this hypothetical scenario, the Federal Aviation Administration would immediately ground all commercial airplanes until the underlying error was recognized and irrevocably fixed. In contrast, the medical profession continues to accept errors that lead to preventable patient harm as an unfortunate and inevitable “side effect” of modern health care. As surgeons, in particular, we have been historically too cavalier and lenient in our attempt to understand, report, and mitigate our own complication rates. Unquestionably, surgeons do not appreciate when their hospital administrators dictate how patients should be treated, and most of us possess an intrinsic adversity to filling out forms and checklists, and adhering to regulatory compliance-mandated paperwork and protocols. Yet, the unintentional void created by the absence of surgeon leadership in the field of patient safety has meanwhile been filled by other stakeholders, including patient advocacy groups, malpractice lawyers, and legislators. The antiquated paradigm of patient safety standards being driven by a fear of medicolegal repercussion has escalated to an unjustified and fiscally irresponsible practice of “defensive medicine.” This historically engraved, negative default must be turned around into a positive force driven by surgeon leadership. It is time for a change in mindset. A famous Chinese proverb fittingly states, “The best time to plant a tree was 40 years ago; the second-best time is now.” Today is the time for surgeons to make up for past negligence by taking the lead in driving patient safety as an irrefutable surgical responsibility.

This first-edition textbook was designed to serve as a guide for resident surgeons in training towards understanding the foundational pillars of surgical patient safety. The book is stratified to 3 main sections that cover (1) the essential nontechnical aspects of surgical patient safety; (2) case-based scenarios related to technical challenges and bail-out options in the operating room; and (3) a variety of additional perspectives by renowned experts in the field. These include Doug Lundy's expert guidance on how to handle malpractice lawsuits (Chapter 20), Mike Victoroff's encompassing chapter on how to recognize and mitigate the dangers of the modern age of electronic health records (Chapter 23), the authoritative physician executive's perspective by patient safety advocate Phil Mehler (Chapter 19), and the pragmatic “IKEA approach” for patient advocacy by bestselling author Pat Mastors (Chapter 22).

I recently attended the fifth annual conference of the “Patient Safety Movement,” a philanthropic foundation guided by the ambitious mission of reducing preventable patient deaths in the United States to zero by the year 2020. In his keynote address, former Vice President Joe Biden stated the memorable quote, “Amateurs practice until they get it right; professionals practice until they never get it wrong.”

I hope this new book will inspire the future generation of surgeons to never get it wrong, for the sake of the well-being of our patients.

Philip F. Stahel, MD, FACS

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