Surgical errors sometimes occur before the surgery even takes place. Before an operation, surgeons perform a preop assessment of the patient to determine whether they are a candidate for the operation. Patients must meet certain indications to be considered for surgery. In addition, the patient must be assessed to determine whether they are fit enough for surgery and the demands of anesthesia. Thus, a history and physical (sometimes called the “preop H&P”) are required. Finally, the doctor must discuss the risks, benefits, options and nature of the surgery to obtain informed consent. Often, medical mistakes are made during this preoperative period that lead to catastrophe during or after the surgery.
Patient selection is determined by the patient’s condition and the available treatment options. Many conditions require surgery, while sometimes surgical options are elective. But, as the saying goes, if you give a man a hammer, the whole world looks like a nail. This is true for surgery. Surgeons are invested in their craft and have a financial incentive to ply it. Sometimes the decision to operate is made in haste.
As an example, I represented a man who had an abdominal aortic aneurysm (AAA) that was big, but not big enough to require surgery. His primary care physician was dutifully monitoring it by getting imaging every year. At some point, images were taken and reported in a preliminary report that suggested the aneurysm had grown to a dangerous size. The patient was referred to a surgeon who promptly operated based on the preliminary report. However, when the final report was prepared, the radiologist compared the recent images with older images and determined that the aneurysm had not grown at all. The surgeon never looked at the final report and the unnecessary AAA repair surgery went forward. Unfortunately, complications occurred during the surgery that resulted in catastrophe — the patient needed bilateral leg amputations.
The preop H&P is another time when errors can occur. For example, a recent study in the Archives of Internal Medicine showed that patients who are hyponatremic (low sodium levels) are at increased risk of perioperative death from infection, cardiac events and pneumonia. However, the study also pointed out that many of the adverse events occurred following elective surgery. This means that the patient’s sodium levels could have been fixed before he/she was taken to surgery. When physicians take unnecessary chances with their patients, and surgical errors occur, there may be grounds for a medical negligence case under Ohio law.
