Surgery can be a lifesaving procedure, but it also carries inherent risks. Even the most skilled and experienced surgeons can make mistakes. So how often do surgical errors really occur? Let’s take a closer look at some key statistics on this important patient safety issue.
What is considered a surgical mistake?
Surgical mistakes, also called surgical errors or surgical “never events,” refer to preventable adverse events that occur during operative procedures. This includes things like operating on the wrong site (for example, the left knee instead of the right), leaving a foreign object inside the patient’s body after surgery, or performing the incorrect procedure altogether.
Other potential surgical errors include:
– Anesthesia mistakes – medication dosing errors, failing to properly monitor vitals
– Injuries to organs, nerves, tissues – nicks, cuts, punctures
– Retained surgical items – sponges, instruments, etc. left inside patient
– Post-op complications – infections, bleeding, pain, slow recovery
– Communication breakdowns – with staff, other providers, patient and family
– Equipment failures – malfunctioning tools, laparoscopes, monitors
Some complications arise even when proper protocols are followed. But medical mistakes that are clearly preventable breaches in the standard of care are considered surgical “never events” – meaning they should never occur.
How common are surgical errors?
Research studies estimate the incidence of surgical mistakes that harm patients:
- 2.9% to 3.7% of all hospitalized patients experience an adverse event due to medical errors, with half occurring during surgical procedures. (HealthGrades 2004 and 2010 studies)
- Postoperative complications occur in up to 17% of inpatient surgical procedures. (Styles et al, 2012)
- Surgical never events occur at a rate of 1 to 5 per 10,000 operating room procedures. (Mehtsun et al, 2013)
Based on this data, a rough extrapolation suggests surgical errors may occur in anywhere from 150,000 to 500,000 surgeries every year in the United States. But the true incidence rate is difficult to measure.
Reporting gaps
There are major gaps in incident reporting which means surgical mistakes often go undetected or unreported:
- Less than 20% of surgical never events are reported. (Hughes et al, 2016)
- Reporting of surgical site infections after hospital discharge is estimated to detect just 14% of occurrences. (Lawrence et al, 2018)
- Technical errors and non-harm “near misses” often go unreported.
This means published statistics likely under-estimate the true rate of surgical errors.
Which procedures have the highest error rates?
Some types of operations appear more prone to errors based on claims data of surgical never events (Mehtsun et al, 2013):
| Procedure | Never Events per 10,000 Cases |
|---|---|
| Spinal surgery | 5.5 |
| General surgery | 3.3 |
| Plastic surgery | 3.1 |
| Orthopedic surgery | 2.6 |
| Vascular surgery | 2.0 |
Complex procedures that involve multiple body systems and surgical teams appear at highest risk for errors.
What types of mistakes are most common?
Looking at malpractice claims data, the most frequent identifiable surgical errors include (CRICO Strategies, 2015; Amin et al, 2022):
- Infection due to contamination during surgery – 17%
- Foreign object left inside patient – 13%
- Surgical site bleeding – 8%
- Anesthesia errors – 5%
- Injuries to internal organs – 5%
Other major factors in surgical mistakes include poor communication between team members, equipment failures, medication errors, patient misidentification, and lack of pre-op planning.
What contributes to surgical mistakes?
Surgical errors rarely have just one cause. Typically many individual and systemic factors align to allow mistakes to occur (Flin et al, 2006):
- Teamwork issues – tension, lack of coordination, communication breakdowns
- Training gaps – inadequate education, inexperience
- Fatigue – surgeons performing too many long operations
- Equipment problems – malfunction, misuse, unavailability
- Patient factors – complex conditions, obesity, urgent cases
- OR distractions – noise, interruptions, emergencies
- Inadequate policies – no protocols, lack of checklists
By recognizing and addressing these potential contributors, hospitals can engage in quality improvement initiatives to enhance patient safety during surgery.
Conclusion
Surgical mistakes are challenging to track but are estimated to occur in up to 5% of operations in the US. Complex procedures like spinal surgery see higher error rates. Retained foreign objects, infections, and bleeding are among the most common preventable surgical complications. Factors like teamwork, fatigue, patient risks, distractions, and lack of protocols contribute significantly. Better reporting, safety initiatives, team training protocols, and surgery checklists can help reduce errors and improve patient outcomes.