Surgical Complications Diagnosis and Treatment
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Advances in the art and science of surgery have resulted in what was only a dream cure yesterday becoming the reality of today; however, complications in the delivery of surgical care can occur, and it is important to distinguish unavoidable complications from those due to error. With good communication and informed consent, patients are more likely to accept unavoidable complications.
Complications due to error can be reduced to a minimum or eliminated by carefully studying the root cause and then instituting fail-safe measures to prevent occurrence. The postoperative period is a ripe source of complications that lends itself to corrective action.
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The postoperative period is an area worthy of study to prevent injuries that would otherwise be avoided by patient safety measures and risk management. Available at: www. Accessed April 17, Tagged as: medical claims , medical liability claims , outcomes , patient assessments , patient safety , postoperative period , postoperative risks , risk management , surgical complications , The Doctors Company.
Bulletin of the American College of Surgeons N. Saint Clair St. Chicago, IL Contents Study of patient injuries Factors leading to claims Recommendations Conclusion. Study of patient injuries To understand the adverse outcomes that patients experienced in the postoperative phase of care, we looked at patient injuries and determined the following: 46 percent of patients represented in these claims and lawsuits died 29 percent experienced postoperative infections not including abscess 14 percent had a puncture or laceration 12 percent required additional surgery 12 percent required hospitalization or prolongation of hospitalization 9 percent had an amputation or other mobility dysfunction 9 percent experienced tissue necrosis 5 percent had an abscess Note: patients may have experienced more than one adverse outcome such as infection and death, so percentages add up to more than percent.
Figure 1. Adverse outcomes Risks unrelated to surgical procedures were identified in the postoperative period as well. Figure 2. Locations where complications occurred The remainder of postoperative complications manifested themselves in the hospital setting 66 percent. Figure 3. Allegations leading to lawsuits Factors leading to claims Physician experts who reviewed these cases for the insurance company identified many of the same issues.
Relationship Between Occurrence of Surgical Complications and Hospital Finances
Examples are as follows: In several cases, patients complained of back pain and numbness or loss of control of lower extremities. Later, CT scans revealed spinal epidural abscesses. The experts opined that neurological consults should have been done earlier to prevent the neurological deficits. Cerebrovascular accidents occurred secondary to anticoagulation therapy or diffuse cerebral hypoxia from bilateral thrombi of sinus veins rare Factor VIII elevation.
Assessment of a patient with free air in the abdomen following colonoscopy should have prompted surgical intervention. The patient suffered shortness of breath, tachycardia, and hypotension. Delay in ordering diagnostic tests was the alleged failure in this case.
The following are examples in which inadequate communication led to claims: In one case, the general surgeon removed a pelvic mass from a middle-aged woman. The mass was a papillary serous cystic tumor of the ovary. After the mass was removed, the surgeon discharged the patient with no referrals for follow-up. Multiple cases involved chest X-ray films with incidental findings of lung or mediastinal masses that went untreated. In another case, nurses attempted to notify a surgeon of a hematoma following inguinal hernia surgery but were unsuccessful for several hours. The hematoma impinged on the blood supply of one testicle causing ischemia and resulting in an orchiectomy.
This raised several questions regarding surgeon availability, surgeon back-up, and the internal chain of command. A patient with a colon mass had a right hemicolectomy. The nurses did not notify the surgeon. A few days later, the patient was admitted to emergency department in cardiac arrest. The autopsy showed gangrene at the site of the anastomosis with perforation and peritonitis.
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Endophthalmitis, on the other hand, carries a significant risk of permanent vision loss even with prompt treatment. Anterior segment ischemia after strabismus surgery. Surv Ophthalmol ; Duration of conjunctival redness following adult strabismus surgery. Recognized globe perforation during strabismus surgery: incidence, risk factors, and sequelae.
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Enroll in the Residents and Fellows contest. Enroll in the International Ophthalmologists contest. Residents and Fellows contest rules International Ophthalmologists contest rules. Original article contributed by :. Robert A. Clark M.
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Donny W. Assigned status Update Pending by Donny W. This page was last modified on September 10, , at This page has been accessed , times. As surgical complications have been presented briefly and sporadically in various books and only as a small part of chapters dealing with surgical techniques, there is a pressing need for a modern textbook dealing with the diagnosis, treatment, auditing, medico-legal implications and ethical problems related to surgical complications.
Written by internationally known authors, the chapters deal with both the general issues regarding the surgical complications and the specific issues related to each surgical specialty. Each chapter includes: clinical presentation; diagnosis clinical, laboratory investigations, imaging ; treatment conservative, surgical ; and outcome.