KARACHI: The four-day 34th International Pak ORTHOCON- 2021 kicked off on Thursday where orthopaedic surgeons presented their cases studies and research papers. The conference was organized by The Pakistan Orthopaedic Association at a local hotel.
Professor Maj-Gen Suhail Amin shared his insights on the topic of surgical errors and complications, saying that all surgeons face complications even master surgeons having decades of experience will occasionally encounter a complication.
He said surgical completions are defined as adverse events that are an acknowledged risk of surgical care (i.e., when a standard surgical procedure is undertaken, there are risks that are not avoidable) Prof Suhail discussed the different type surgical errors or mistakes like avoidable commissions or omissions with potentially negative consequences, preventable adverse events and judged as poor practice by skilled and knowledgeable peers at the time when they occurred.
He said that it is important to deal with surgical errors because they need to restore a good functional outcome to our patient and need to learn from it so as to minimize the risk of future occurrence.
He also discussed a three pronged strategy to deal with surgical errors - Preoperative evaluation, Intra-operative techniques and Post-operative management.
He said the preoperative evaluation is important because it can alert us to risk factors for potential complications. Thorough assessment of diabetics pre-operatively is necessary and so is careful assessment of obesity, patients on steroids due to any medical condition and all need to be thoroughly optimized to reduce risk of complications.
Explaining the increased risks to the patient before surgery is an important part of the informed consent process. Surgeons who explain the risks of a complication ahead of time are seen as wise for seemingly predicting it, whereas surgeons who fail to inform the patient may even be perceived as causing the complication. Patients due for TKR with h/o IHD, strokes, etc., need to be explained higher risks of cardiovascular complications.
Knowing about the preoperative status of the patient can also help surgeons prepare for the surgery by having additional equipment ready. Example is preparation for complex trauma cases or complex primary or revision arthroplasty cases.
Prof Suhail said there are often subtle clues ahead of time that may alert the surgeon to an impending complication. In Bipolar hemiarthroplasty for elderly females, proximal femur is quite osteoporotic and an astute surgeon should be able to detect and handle the bone accordingly while preparing the canal to avoid fractures.
Once the complication happens, surgeons must act efficiently and carefully to control the situation and prevent further problems. Staying calm, assessing the situation carefully is important. The surgeon also needs to get through the case without doing further harm. At times you may need referral to a better facility.
On post-operative management, Prof Suhail was of the view that soon after the surgery; patient should be informed of the complication. Even if a surgeon did not directly cause the complication, it is fine to apologize that the complication occurred.
The patient just wants to know that the surgeon truly cares and will do everything possible to ensure the best possible recovery. Patients with complications are not looking to blame anyone; they just want to avoid being abandoned and they want help on their road to recovery.
Keep these patients closer, see them more often for follow-up care, and make it easy for them to contact you if need be. "Patients who have had intra-op complications can be at risk for more issues in the post-op period", he added.
Although difficult to measure, he said, it is clear that cognitive errors are common and frequently have disastrous results, adding that taking time to think is an aspect of diligent behaviour; cognitive diligence and cognitive skill are both necessary to minimize errors.
He said affective errors in cognition occur due to poor decision-making -decision based on what we wish to be true.
He cited insights in prevention of surgical errors given by American College of Surgeons are: Surgeons are subject to fatigue, distractions, time constraints, competing priorities, workload, burnout, and many other factors that can affect professional behaviour and cognition.
Other variables over which there is little control, like system factors can also adversely affect success at the point of service. To reduce surgical errors and mistakes, he suggested that medical records need to be clear and unambiguous.
SOPs should dictate exactly how drugs, in particular high-risk drugs, should be checked, prescribed, dispensed and delivered. Health-care workers must embrace the concept of patient engagement. Provision of informational care to patients cannot be over-emphasized. Dr Ahmet Salduz from Turkey and other speakers also presented their papers and case studies.
Copyright Business Recorder, 2021
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