Occupational Health & Safety

Study Estimates 4,000 Surgery Errors Per Year in US

The Johns Hopkins University School of Medicine patient safety researchers studied national malpractice claims to form their estimate, which is reported online in the journal Surgery.

Patient safety researchers from the Johns Hopkins University School of Medicine estimate a startling number of "never events" -– mistakes the profession agrees should never happen during surgery -– take place in the United States: A foreign object such as a sponge or a towel is left inside a patient's body after an operation 39 times per week, surgeons perform the wrong procedure on patients 20 times per week, and they operate on the wrong body site 20 times per week. The research, reported online in the journal Surgery, involved what the school's news release describes as "a cautious and rigorous analysis of national malpractice claims."

The researchers calculated 80,000 "never events" occurred in American hospitals between 1990 and 2010 and said they believe this is probably an underestimate of the real total. They said quantifying the national rate of "never events" is important for the development of better systems to ensure such events are prevented.

"There are mistakes in health care that are not preventable. Infection rates will likely never get down to zero even if everyone does everything right, for example," said study leader Dr. Marty Makary, M.D., MPH, an associate professor of surgery at the school. "But the events we've estimated are totally preventable. This study highlights that we are nowhere near where we should be, and there's a lot of work to be done."

Makary and colleagues including Dr. Winta T. Mehtsun, M.D., MPH; Dr. Andrew M. Ibrahim, M.D.; Marie Diener-West, Ph.D.; and Dr. Peter J. Pronovost, M.D., Ph.D. used the National Practitioner Data Bank, a federal repository of medical malpractice claims, to identify malpractice judgments and out-of-court settlements of "never events" during the 20-year period. They found 9,744 paid malpractice judgments and claims with payments totaling $1.3 billion. "Death occurred in 6.6 percent of patients, permanent injury in 32.9 percent and temporary injury in 59.2 percent," according to the school's release. "Using published rates of surgical adverse events resulting in a malpractice claim, the researchers estimate that 4,044 surgical never events occur in the United States each year. The more serious the outcome, the more the patient (or his family) was paid."

Makary noted these are not the sort of claims for which frivolous lawsuits are filed or settlements are made to avoid jury trials. "There's good reason to believe these were all legitimate claims. A claim of a sponge left behind, for example, can be proven by taking an X-ray," he said.

Hospitals are required by law to report never events that result in a settlement or judgment to the data bank. The estimates of never events are low because not all items left behind after surgery are discovered, Makary said. He said public reporting of never events would help consumers make better choices about where to undergo surgery and would "put hospitals under the gun to make things safer."

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