The British Medical Journal: Quality and Safety recently published a study evaluating the role equipment and technology play in surgical mistakes. The article appeared on July 25 on the journal’s web site and is titled, “Surgical technology and operating-room safety failures: a systematic review of quantitative studies.” The nine researchers, all of whom are affiliated with Imperial College, London (some from the departments of surgery and cancer, some from the Imperial vascular unit, and one from the clinical safety research unit), accumulated a pool of 19,362 incidents involving intraoperative mistakes before narrowing their focus to a highly detailed reading of 28 cases.
The lead author writes, “Surgical technology has led to significant improvements in patient outcomes. However, failures in equipment and technology are implicated in surgical errors and adverse events. We aim to determine the proportion and characteristics of equipment-related error in the operating room (OR) to further improve quality of care.” Though this research survey was conducted in the United Kingdom, its results are very relevant to the United States, in which better technology is often equated in the public mind with better results. As we shall soon see, this is not always the case.
Researchers found that “[f]ailures of equipment/technology accounted for a median 23.5 [percent] of total error.” Moreover, there was a median of about one equipment problem per operation (.9), which is startling. Further results found that “those [surgeries] with a greater burden of technology/equipment tended to show higher equipment-related error rates,” and that the simple solution of using a checklist during a procedure was able to reduce equipment errors by nearly half (48.6 percent). Equipment-specific checklists, by comparison, reduced errors by over 60 percent when used.
Noted Johns Hopkins surgeon and professor Marty Makary stated while speaking on NBC’s Rock Center about new robotic surgery techniques, “We’ve got great, state-of-the-art, minimally invasive techniques that have worked for years, sometimes decades, that are now being replaced with more expensive robotic technology, without a benefit to the patients.” He has also, in the Chicago Tribune, called robotic surgery systems like Intuitive Surgical’s da Vinci (currently facing a growing number of lawsuits and mounting FDA scrutiny), “the symbol of the current American health care marketplace–rapid widespread adoption with little to no evidence to support it and increased costs.”
Indeed, these Imperial College doctors conclude: “Equipment-related failures form a substantial proportion of all errors occurring in the OR. Those procedures that rely more heavily on technology may bear a higher proportion of equipment-related error.” Especially in the United States, a country with the highest health expenditure per capita in the world, this should send the message that flashy, exciting and expensive techniques are not always the most effective. And they are rarely the cheapest.
The tort reform advocates point to trial attorneys as the cause of the so-called crisis in health care, but in fact, as the evidence indicates, the malpractice crisis is caused by professional negligence. And now the risk of injury is increased by new robotic surgeries that are not yet ready for prime time.
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