The importance of side marking in preventing surgical site errors

BACKGROUND: Wrong site confusions are among the most common mistakes in operations of twosome organs. PURPOSE: To examine the frequency of wrong sided confusions that could theoretically occur in various surgeries in the absence of preoperative verification. METHODS: Ten cataract surgeons, twelve orthopedic surgeons and 6 ENT surgeons participated in the study. The surgeons were asked to fill a questionnaire that included their demographic data, occupational habits and their approach to and handling of patients preoperatively. On the day of operation the surgeons were asked to recognize the side of the operation from the patient's name only. At the second stage of the study, surgeons were asked to recognize the side of the operation while standing a two meter distance from the patient's face. Surgeons' answers were compared to the actual operation side. Patients then underwent a full 'time out' procedure, which included side marking before the operation. RESULTS: Of a total of 67 ophthalmic patients, 52 orthopedic patients and 26 ENT patients the surgeons correctly identified the operated side in 111 (76.5%) by name and in 126 (87%) by looking at patients' faces. Wrong side identification correlated with the time lapsed from the last preoperative examination (p = 0.034). The number of cataract surgeries performed by the same surgeon (on the same day) also correlated to the number of wrong identifications (p = 0.001) in ophthalmology. Orthopedic surgeons were more accurate in identifying the operated site Surgeon seniority or age did not correlate to the number of wrong identifications. CONCLUSIONS: This study illustrates the high error that can result in the absence of side marking prior to cataract surgery, as well as in operations on other twosome organs.