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At least 19 recordsLinked to original sources
PubMed1996

In vitro femoral stiffness after femoral neck osteotomy and osteosynthesis with defined surgical errors.

In our search for an osteosynthesis device that would tolerate the surgical errors of the inexperienced surgeon, we tested in vitro femoral stiffness in 75 human osteoporotic femora after internal fixation of a cervical neck osteotomy using three commonly used devices: two von Bahr screws (A. Ericsson AB, Sweden), two cannulated screws (Uppsala type, Olmed AB, Sweden), and two hookpins (LiH, PSAB, Sweden). The first device has its main grip in the cancellous bone by threads; the second has grip in cancellous and subchondral bone by threads; and the third, which has no threads, has its grip in cancellous bone by a hook pin. The intact specimen was in all instances stiffer (22-63%) than the osteosynthesized specimen (p < 0.001). An osteosynthesized femur with perfectly reduced bone ends was 14-23% stiffer than when reduction of the bone ends was insufficient, irrespective of device malposition (p < 0.001). Insufficient reduction of the osteotomy leaving a 20 degrees dorsal angulation of the femoral head combined with too far ventrally placed screws resulted in the lowest femoral stiffness. If reduction of osteotomy was sufficient, screws placed too far ventrally or converging screws did not result in decreased stiffness compared with optimal screw placement. Irrespective of the quality of reduction, osteosynthesis with the Uppsala screw resulted in all instances in a higher stiffness than using the other devices (p < 0.01). With the Uppsala screw design, femoral stiffness after optimal osteosynthesis was reduced by 22% compared with the intact femur, and in the most unfavorable position with combined malreduction and malpositioning it was reduced by 42%. Corresponding values for the von Bahr screws were 29% and 46%, respectively, and for the LiH screws 47% and 63%, respectively. Use of a device with threads and grip in the subchondral bone is recommended for fixation of femoral neck fractures in osteoporotic bone. Furthermore, the importance of anatomical reduction for fracture fixation is emphasized.

Aged↗
PubMed2003

Using human reliability analysis to detect surgical error in endoscopic DCR surgery.

The aim of this study was to describe the nature of active skill-based errors occurring in endoscopic dacrocystorhinostomy (DCR) surgery. A human reliability analysis methodology was used to assess surgical error from observational capture data. Twelve endoscopic DCR operations performed by three different surgical trainees were video recorded. The steps (subtasks) of each operation were carefully analysed and common errors were documented. Specific errors that resulted in trauma to the nasal mucosa were noted. Execution errors were common, with errors of grasping being most frequent (67% of all execution errors). Most of these involved the Blakesley forceps. In total, there were 69 mucosal trauma hits. Inserting instruments into or withdrawing them from the nasal cavity with too much force or speed caused more than half of these. Incising with too much force resulting in 'overshoot' caused 34% of mucosal trauma. Trainee ENT surgeons should take particular care when inserting or withdrawing instruments from the nasal cavity and also when performing lacrimal sac or nasal mucosa incisions. Performance of these tasks with too much force was identified as a common and potentially avoidable cause of mucosal trauma. Further research is needed into the design and use of endoscopic sinus surgery instruments with the aim of avoiding the errors that were encountered.

Dacryocystorhinostomy↗
PubMed1999

Complications after carotid endarterectomy are related to surgical errors in less than one-fifth of cases. Swedvasc--The Swedish Vascular Registry and The Quality Committee for Carotid Artery Surgery.

OBJECTIVES: to study possible relations between indications, contraindications and surgical technique and stroke and/or death within 30 days of carotid endarterectomy (CEA). DESIGN: analysis of hospital records for patients identified in a national vascular registry. METHOD: during 1995-1996, 1518 patients were reported to the Swedish Vascular Registry - Swedvasc. Among these the sixty-five with a stroke and/or death within 30 days were selected for study. Complete surgical records were reviewed by three approved reviewers using predetermined criteria for indications and possible errors. RESULTS: an error of surgical technique or postoperative management was found in eleven patients (17%). In six cases (9%) the indication was inappropriate or there was an obvious contraindication. The indication was questionable in fourteen (21.5%). Half of the patients (52.5%) had surgery for an appropriate indication, and no contraindication or error in surgical technique or management was identified. CONCLUSION: more than half the complications of CEA represent the "method cost", i.e. the indication, risk and surgical technique were correct. However, the stroke and/or death rate might be reduced if all operations conformed to agreed criteria.

Aged↗
PubMed2003

The surgical error examination is a novel method for objective technical knowledge assessment.

BACKGROUND: Objective analysis of surgical skill is necessary. A novel method of assessment using simple error analysis in synthetic models is examined for construct validity. METHODS: Two examination protocols were devised using synthetic models. These contained either a purpose made error or were representative of good surgical practice. Protocol one contained models of skin closure and minor operations. Protocol two in addition more complex procedures. Face validity was established by the approval of senior surgeons. Junior surgeons were recruited to undertake the assessment. A p value of less than 0.05 was deemed to be significant. RESULTS: Eighty-nine surgeons were recruited. Both protocol one and two were able to discriminate between groups at statistically significant levels. CONCLUSIONS: Construct validity has been established by showing that error analysis is able to distinguish surgeons with varying levels of experience.

Clinical Competence↗
PubMed1978

[Avoidable surgical errors in hallux valgus surgery according to Brandes (author's transl)].

In postoperative follow-ups in a large number of patients who underwent Hallus valgus surgery according to Brandes, residual pain was found due to insufficient resection of the proximal phalanx. It is pointed out that the results of this frequent and beneficial Hallux valgus surgery can be improved by using a more subtile surgical technique. Figs. 1-5 show that errors continue to be made. If these errors can be avoided in the future this report will have fulfilled its purpose.

Hallux Valgus↗
PubMed1988

[Surgery of varicose veins. Surgical errors and complications].

It is necessary to distinguish between complications that cannot be avoided and those that can through knowledge of the special risks of the surgical procedure. Special complications that cannot be avoided include bleeding in the saphenous channel, loss of sensitivity, damage of lymphatic vessels, pigmentation of the leg, and the very rare postoperative pulmonary embolization. A preoperative diagnosis based on a careful physical examination, phlebography and Doppler ultrasound will help avert unnecessary mistakes.

Humans↗
PubMed2000

Surgical error: ethical issues of adverse events.

We all recognize and accept that adverse events occur with some frequency in surgery and that all departments meet regularly to review them. Since adverse events and "mistakes" have the potential for delaying recovery and injuring surgical patients, an ethical mandate exists to do all that can be done to prevent harm. This article suggests that there are 5 issues within the practice of surgery that have inhibited improvement in quality: (1) inadequate data about the incidence of adverse events, (2) inadequate practice guidelines or protocols and poor outcome analysis, (3) a culture of blame, (4) a need to compensate "injured" patients, and (5) difficulty in truth telling.

Clinical Protocols↗
PubMed1978

[Diagnostic and surgical errors in congenital hydronephrosis in children].

34 children with congenital hydronephrosis, operated upon for erroneosly diagnosed acute appendicitis (17), malignant tumor (11), and ileus (8), were under observation. To prevent from unwarranted surgical interventions in dubious cases excretory urography and other x-ray and instrumental methods of examination must be used widely. After the removal of an unchanged vermiform process in children, suffering from abdominal pain, the examination of the urinary tract is indicated. Such patients should be under dispensary observation of a children's surgeon.

Adolescent↗