Wrong site surgery in otolaryngology–head and neck surgery

Authors

  • Tzyy-Nong Liou BS,

    1. Department of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, U.S.A.
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  • Brian Nussenbaum MD, FACS

    Corresponding author
    1. Department of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, U.S.A.
    • Send correspondence to Brian Nussenbaum, MD, FACS, Department of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8115, St. Louis, MO 63110. E-mail: nussenbaumb@ent.wustl.edu

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  • The authors have no funding, financial relationships, or conflicts of interest to disclose.

Abstract

Objectives/Hypothesis

Wrong site surgery has received high public awareness this past decade, yet discussion specific to otolaryngology is limited.

Study Design

Literature review.

Methods

We searched the MEDLINE database on PubMed from 1980 to 2013 and pursued the citations of key references further. We conducted a review of the literature and public patient safety reports on the scope, root causes, and prevention of wrong site surgery with emphasis on otolaryngology.

Results

A review of the literature reveals that otolaryngology procedures constitute 0.3% to 4.5% of all wrong site surgery events, and wrong site surgery accounts for 4% to 6% of all medical errors in otolaryngology. A significant proportion (9% to 21%) of otolaryngologists reported experiences with wrong site surgery over their career, and the events most frequently resulted in temporary injuries to the patient with few cases of permanent disability or death. Although otolaryngology procedures have similar root causes for wrong site events as other specialties, inverted imaging and ambiguity in site marking are particular challenges. Site-marking practices are variable among otolaryngologists, as it is not applicable to many otolaryngology procedures, yet these are common procedures that also constitute the majority of wrong site cases reported in otolaryngology.

Conclusions

Future interventions to address these challenges related to otolaryngology–head and neck surgery might involve a standardized protocol to confirm imaging accuracy, a specialty- or procedure-specific checklist, a standardized alternative to site marking when marking is impractical, and other innovations. Evaluation of these interventions is becoming easier given the increasing mandatory reporting of these events that provides more reliable incidence data. Laryngoscope, 124:104–109, 2014

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