Saving life during surgery

"A surgeon left a sponge inside his patients." "A patient died of fatal infection after surgery due to the failure to ensure sterility." These are commonly reported surgical mistakes in Bangladesh. Many others are not reported. Whether we a have a statistics or not, we all admit that mistakes happen. And the fact is, more than half of these mistakes are avoidable.
Not just in developing countries like Bangladesh, more than 60% of patients worldwide including developed countries have one of six key safety measures missed during surgery. Almost 7 million surgical patients would suffer significant complications each year, 1 million of whom would die during or immediately after surgery.
Considering surgical mistakes as a major public health problem, World Health Organisation (WHO), took an initiative to reduce avoidable deaths due to unsafe surgery. After years of discussion, research and input from anesthesiologists, operating theatre nurses, surgeons, patients and other professionals the WHO expert team developed an effective tool- The Checklist.

The checklist involves a series of simple checks such as ensuring that the correct patient is on the table, operating on the right part of the body, anesthesia machine is working properly and ensure everyone and everything is prepared to manage any complications. The checks are done in three situations in a surgical procedure- before induction of anesthesia, before skin incision, before patient leaves the operative room.
This is a short-one page 19 item checks that takes only 3 minutes but the impact is enormous. Data suggests that at least half a million deaths per year would be preventable with effective implementation of the WHO Surgical Safety Checklist worldwide In sites that ranged from small district hospitals to large medical centers in diverse geographical settings, the use of a 19-item checklist was demonstrated to reduce the complications and mortality associated with a variety of surgical procedures by greater than 30%. Moreover, the effect was of similar magnitude in both high and low/middle income country sites. Even in place like rural Tanzania, hospitals were able to implement the checklist and see substantial improvements in outcomes, all at essentially no cost to the system. The Checklist has not only impacted outcomes, but it has also improved communication among the surgical team, and thus quality of care.
234 million major operations are performed annually across the world-roughly one operation per every 25 people. With the increasing use of complex technology, number of procedures and complexity in medicine, mistakes are inevitable. Such as all patients should receive an antibiotic within one hour before the incision is made, a practice known to reduce the rate of surgical-site infections by up to 50%. But antibiotics are not given consistently, even in the most sophisticated health centers. An estimated 200-300 'wrong-person' operations taking place each year in most developed country in the world like USA. It sounds silly but happens everywhere. The simple solution to avoid most of these complications is a checklist.

E-mail: rajib.hossain@thedailystar.net