What can go wrong during preparation for surgery?

It is widely recognised that all operative procedures carry recognised risks and it is important to remember that not all complications suffered as a result are due to negligence. However, there are situations which can arise during the preparatory stages of operations that are not considered to be a recognised risk or acceptable conduct, such as:

Administering a patient with insufficient local anaesthesia and continuing with an operation regardless. This will inevitably result in the patient suffering unnecessary pain, and can often leave them with a fear of returning to hospital for further procedures.

Administering a patient with an overdose of anaesthesia, which can often result in respiratory failure and long term associated health difficulties.

Failure to provide patients with anti-coagulating (blood thinning) medication prior to surgery. Anti-coagulants are not administered to all patients routinely, as they carry risks of their own (most notably a higher risk of excessive blood loss during surgery). However, if a patient is significantly overweight, a smoker, and / or has a past medical history of strokes or DVT’s then it is considered appropriate to at least consider the need for anti-coagulation medication. Failure to administer anticoagulation medications can sometimes result in blood clots, which can be responsible for post-operative complications such as heart attacks and strokes.

What should a hospital do to minimise these risks?

Not all risks can be avoided, but if you intend to undergo a pre-planned operation, then there are certain steps that should be taken by your medical care provider to minimise the risk of things going wrong:

1. The staff caring for you should arrange a pre-operative consultation to explain the procedure and associated risks to you in detail. You will usually be asked to sign a consent form as well to confirm that you understand what has been explained to you. This consent form is unlikely to detail all of the possible risks associated with your procedure, but it should highlight the most serious and the most common ones.

2. During your pre-operative consultation, a doctor or nurse should run through a list of questions about your past medical history and make a record of this, particularly in relation to:

Any medical conditions you may have
Any medications you might be taking
Any past operations you may have had
Any allergies you may have Any specific worries you may have

3. A risk assessment form should be completed by the hospital once you have given them the personal information they require.

4. Some basic observations (ie temperature, pulse, blood pressure) are likely to be recorded during your pre-operative consultation and again on the day of your operation.

5. Either prior to, or on the day of, your operation, blood or mouth swabs should be taken to screen you for pre-existing infection (particularly MRSA and other infections prevalent in hospitals). It may be that you will need a course of anti-biotic treatment prior to undergoing your operation.

6. Prior to your operation, you should be given clear instructions regarding what you can eat and drink, and also given guidance regarding taking medications (either long standing medications or new ones).

Case examples:

Thompsons Solicitors are experienced in representing patients who have suffered pre-operative complications, such as:

- Mr X was admitted to hospital for a pacemaker insertion. Unfortunately, whilst conscious but sedated in the catheter lab, a spark from the diathermy device used to prepare Mr X for surgery ignited a pool of flammable chlorhexidine antiseptic solution, resulting in first degree burns to Mr X’s chest. Fortunately, no hardware had been implanted at the time of the fire and as such the procedure was abandoned and the wound closed in two layers. Mr X’s operation was therefore delayed, he suffered extensive burn injuries and considerable psychological difficulties as a result of the incident.

- Mrs Y was admitted to hospital to undergo a D&C, following a miscarriage. Unfortunately, she was administered insufficient anaesthetic and experienced considerable pain and discomfort during the procedure. Despite raising her concerns to the doctor involved during the procedure, he proceeded to complete the operation in any event. As a result, in addition to the pain and suffering, Mrs Y suffered considerable psychological injury including nightmares and a fear of returning to hospital.

Post operative complications

In addition to mistakes being made during surgical preparation, mistakes and complications can also arise post-operatively.

What can go wrong post-operatively?

It is widely recognised that all operative procedures carry recognised risks and it is important to remember that not all complications suffered following an operation as a result are due to negligence. However, there are situations which can arise post operatively that are not considered to be a recognised risk or acceptable conduct, such as:

Failing to detect and treat a hospital acquired infection, such as MRSA. It is important to bear in mind that the contraction of such an infection is often unable to be attributed to negligent conduct of the hospital, but a failure to act on the infection and treat it is likely to be considered unacceptable.

Failing to provide anti-coagulation post operatively, or failing to provide a plan of action for the patient to follow post discharge. Please note that not all patients will require anti-coagulation, but those who have been identified as requiring it pre-operatively should be given clear instructions for the administration of anti-coagulation drugs following discharge.

Delay in detecting a post-operative bleed, and/ or a delay in scheduling a patient for further, remedial surgery to rectify the bleed (or any other complications).

What should a hospital do to minimise these risks?

Not all risks can be avoided, but there are certain steps that should be taken by your medical care provider to minimise the risk of things going wrong post-operatively:

1. Regular observations of the patient should be recorded post-operatively, including blood pressure, heart rate and respiratory rate. These should be compared to the pre-operative observations.

2. Blood samples, urine samples and mouth or nose swabs should be taken to check for infection.

3. The patient and their family should have a clear indication, pre-operatively, of how long they should expect to be kept in hospital. Should the length of their stay become extended or shortened, a clear explanation for this should be provided by health care staff.

4. A clinical review by a doctor should be conducted prior to discharge, and the patient should be given the opportunity to raise any concerns or queries he / she may have.

5. The patient should receive clear instructions for their aftercare follow up plans prior to discharge.