Surgical Errors Part II: Wrong Site Surgery and Antibiotics

Dear All, I got a chance to listen to a talk by Dr. James Herndon, who is a past president of the American Academy of Orthopedic Surgery (AAOS). He is a distinguished professor of surgery who wanted us to know more about things to improve upon in reducing surgical errors. Please put this information on your radar screen if you or your friend is going to get surgery because it might be of help.

My video is on: 1) wrong site surgery (when the wrong place is operated on by accident) and 2) people not getting antibiotics when they should be and/or getting too much antibiotics when they shouldn't be.

References:

1) For more information on wrong-site surgery and simple solutions to prevent it:

a) This is a piece by the American Academy of Orthopedic Surgery http://www5.aaos.org/wrong/setup.cfm

b) This is a commentary by Dr. Herndon
http://www.jbjs.org/Comments/2003/cp_feb03_herndon.shtml

For Information on Antibiotics:

I misspoke in the video. The actual figure is: 44% who need antimicrobials weren't receiving them (Bratzler et al., 2005; see below).

This paper talks about antibiotics and how enough people aren't getting them:

1) Bratzler DW, Houck PM, Richards C, et al. Use of Antimicrobial prophylaxis for major surgery. Arch Surg. 2005; 140:174-182.

Some noteworthy parts from the paper:
"RESULTS: An antimicrobial dose was administered to 55.7% (95% confidence interval [CI], 54.8%-56.6%) of patients within 1 hour before incision. Antimicrobial agents consistent with published guidelines were administered to 92.6% (95% CI, 92.3%-92.8%) of the patients. Antimicrobial prophylaxis was discontinued within 24 hours of surgery end time for only 40.7% (95% CI, 40.2%-41.2%) of patients. CONCLUSION: Substantial opportunities exist to improve the use of prophylactic antimicrobials for patients undergoing major surgery."

Please e-mail me for more references if you need them at: unitedstatesmedicalstudent@gmail.com

General idea behind these health videos:
I'm a first year medical student here at the U.S.. Every day, I'm learning exciting and critical topics on medicine and health. But too often, the things I'm learning about never reach the public.

I wanted to try an experiment -- sharing health information on youtube, with the sole purpose of trying to get more important health information to you all. Unlike some of the other health videos out there, mine are not about promoting a book, a diet, a pill, an agenda. I hope to answer your questions either through e-mail or through the video updates -- please, please, (please!) e-mail me any questions and I will try my best to answer them by asking my professors and by citing credibles sources (JAMA, New England Journal of Medicine, etc...)

e-mail:
unitedstatesmedicalstudent@gma il.com

I hope this experiment works -- and if it fails, I hope someone sees these videos, says, "hmmm, these are bad videos, but I love the idea," and decides to go for it.


___________

P.S. I wanted to point out something important: I'm just a medical student, so my posts are hopefully conversation starters, but only conversation starters — not medical advice. If my posts intrigue you, please read more about the topic and discuss about it with your doctor. I'd be happy to send you the information in the journal articles I talk about. Also, the opinions expressed in this post are not necessarily those of Harvard Medical School, its affiliated institutions, or Harvard University. Best wishes!

Category:

Howto & Style

Tags:

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• orthopedic
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• errors
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• shoulder
• knee
• hip

[missbussy10]

interesting subjects you talk about. You have ay idea if in the future, tablets are becoming more specified on the individual patient? If you look to the individual, seize, weight and age from the patient? Perhaps you can give also a college about this subject on Youtube. Anyway your videos are really eye-openers!

[usmedstudent]

Thanks for your comment! Some drugs are becoming more specific -- like the lung cancer drug Iressa, which works for certain people with a specific EGFR gene type. Unfortunately, there's still a lot of work needed, but hopefully drugs will be less toxic, more specific in the future.

[sallygator]

excellent- thankyou

You graduated yet?

[edmundseloy]

hey dude if your institution dsnt practice surgical perioperative calls prior to the strt of operation then it is bound that some of your surgery will go wrong. ^^ example a circulating nurse identifies the OR Team by calling their names after that the name of the patient the operation to be performed etc. that simple.. makes a more safer Operation ^^

[nico3212]

hear this guy.

it is no one's fault that doctors do wrong site surgery.

well mate--welcome to the industry of medieval medicine.

never compares to greek medicine that really cares for the cure and not make money on the symptoms

[adnansaami]

hey antimicribial prophylaxis that are given pre op, should they be gives 30 mins before incision??? wht about if a surgeion gives it 45-50 mins before incision? say of a knee replacement

[TheMakhai]

I've had three knee surgeries. Before each one my doctor came in and marked the correct knee with his initials and had me verify it verbally.

He was an extremely good orthopaedic surgeon. I can imagine I would have been pretty upset had he tried to operate on the wrong knee. They were arthroscopic so they were fairly non-invasive as far as surgery goes, but still.

Thank you for all of your videos it is really cool to see your progress from 1st year med student to now.

Take it easy.

[cdubs136]

i love your videos, don't be surprised if i comment on all of them. but i do wonder ... are the 24hr abx after surgery IV, or does po cover it? I'm a med school hopeful trying to rise from a not-so-wonderful past.  i aspire to be a cutter. keep doing what you are doing. best of luck to you.

[chuele]

Good idea to use YouTube to draw attention to this issue. There's a new product called "The CheckSite System" (manufactured by CheckSite Medical, Inc.) which uses bracelet technology to ensure that 100% of surgeons mark the surgical site in pre-op. It's extremely effective and not expensive.

[freezzertime]

I hope you received my message. I know you will accomplish your goals.