This occurs as a contributory factor in the reason for settlement in nearly half of all surgical claims and up to 62% depending on specialty. We studied in more detail a randomised sample of 100 of those claims. The reasons for concern over surgical technique can be broken down into six further causes:
- inadequate performance – 34%
- collateral injury – 27%
- cosmetic quality – 24%
- retained equipment – 8%
- incomplete procedure – 4%
- choice of implant – 3%
1. Inadequate performance
Inadequately performing surgical procedures affected virtually all the surgical specialties and simply meant that the particular method the surgeon had adopted couldn’t be fully supported by his or her peers. Examples include not converting to an open cholecystectomy following significant blood loss in a patient with dense adhesions or poor suturing technique following a breast augmentation procedure.
Risk management point 1
Ensure you perform a sufficient number of surgical procedures so as to maintain your skill level. If you were to experience difficulty in a procedure, is help available?
2. Collateral injury
Of particular interest are the 27% of settlements where some form of collateral injury has occurred. One third of these cases involved the use of some form of endoscope. Around a quarter of the collateral injury reasons involved laparoscopes; 6% endoscopes. Again, the range of surgical procedures involved fell across the breadth of surgical specialties varying from corneal burns during eyelid surgery, injuries to peripheral nerves during fracture manipulations and perforation of the bowel during liposuction.
Risk management point 2
When using any form of invasive scope, you will be expected to have discussed the specific risks of collateral injury with your patient as part of the seeking of valid consent. Do you have a sufficiently broad field of vision and can you interpret the anatomy correctly?
3. Cosmetic quality
Of those surgical technique cases settled because of an unsatisfactory cosmetic quality (the inference being the underlying technique was not satisfactory), all of these occurred in plastic/cosmetic practice. Nearly half were breast procedures and a third were facial operations. This reminds us to ensure patients having any form of surgical procedure (but in particular cosmetic procedures) must be allowed to make fully informed choices, and do not have unduly high expectations of outcome.
Ensure you have properly assessed your patient’s expectations of the proposed surgical procedure and addressed any unrealistic outcomes. You must always ensure you have obtained and documented valid consent and advised your patient of the risks of the procedure they face. You should decide whether it is still appropriate to proceed if the patient remains unrealistic in his or her expectations.