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Patient compliance in avoiding wrong-site surgery.

Christopher W DiGiovanni1, Lana Kang, Jennifer Manuel

  • 1Department of Orthopaedics, Brown University School of Medicine, Providence, Rhode Island, USA. yodigi@aol.com

The Journal of Bone and Joint Surgery. American Volume
|May 3, 2003
PubMed
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Many patients undergoing elective orthopaedic surgery fail to follow instructions to prevent wrong-site surgery. This highlights the need for increased patient engagement in surgical safety protocols.

Area of Science:

  • Orthopaedic Surgery
  • Patient Safety
  • Surgical Complications

Background:

  • Wrong-site surgery is a preventable yet devastating complication in orthopaedics.
  • Historically, responsibility for prevention has focused on healthcare professionals, with limited attention to patient roles.
  • Effective surgical outcomes depend on a collaborative doctor-patient relationship.

Purpose of the Study:

  • To investigate patient compliance with preoperative instructions designed to prevent wrong-site surgery.
  • To test the hypothesis that a significant number of patients do not adhere to these safety guidelines.

Main Methods:

  • Prospective evaluation of 100 consecutive patients undergoing elective orthopaedic surgery.
  • Patients were instructed to mark "NO" on the extremity not requiring surgery.

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  • Compliance was categorized as full, partial, or noncompliance; demographic and surgical factors were analyzed.

    • Main Results:

    • Only 59% of patients fully complied with marking instructions; 37% made no mark, and 4% were partially compliant.
    • Noncompliance was higher in patients with Workers' Compensation claims (70%) versus those without (33%).
    • Patients with prior related surgery showed higher noncompliance (51%) compared to those without (29%).

    Conclusions:

    • A significant proportion of patients do not follow explicit instructions to prevent wrong-site surgery.
    • Patient noncompliance suggests an expectation that the healthcare system will manage all safety aspects.
    • Encouraging active patient participation is crucial for optimizing surgical outcomes and minimizing risks.