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Wrong-sided and wrong-level neurosurgery: a national survey.

Balraj S Jhawar1, Demytra Mitsis, Neil Duggal

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Incorrect-site surgery (ICSS) in neurosurgery is rare but occurs. Fatigue, time pressure, and emergent cases contribute to these errors. Prevention requires recognizing risk factors and using more intraoperative imaging.

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Area of Science:

  • Neurosurgery
  • Patient Safety
  • Surgical Error Analysis

Background:

  • Operating at the wrong site (wrong-site surgery, WSS) is a critical patient safety concern in surgery.
  • Neurosurgery, involving complex procedures, faces unique challenges in preventing WSS.

Purpose of the Study:

  • To determine the incidence of incorrect-site surgery (ICSS) among neurosurgeons.
  • To identify potential determinants contributing to ICSS in neurosurgical procedures.

Main Methods:

  • An anonymous survey was distributed to neurosurgeons.
  • Surgeons reported the number of specific procedures (craniotomies, lumbar/cervical discectomies) performed and any ICSS occurrences.
  • Detailed questions addressed potential contributing factors to ICSS.

Main Results:

  • An estimated 12.8 ICSS per 10,000 lumbar discectomies, 7.6 per 10,000 cervical discectomies, and 2.0 per 10,000 craniotomies were reported.
  • Key contributing factors identified include fatigue, time pressure, emergent operations, unusual patient anatomy, and failure to use radiography for site verification.

Conclusions:

  • Neurosurgical ICSS, while rare, does occur.
  • Recognizing risk factors and increasing the use of intraoperative imaging are crucial for preventing ICSS.