Patient Safety in Surgery

Featured article: Unnecessary invasive procedures – the “hidden danger” for patient safety?

The threat of unnecessary surgery for patient safety has been publicized as far back as the 1950s, when Dr. Paul Hawley, the Director of the American College of Surgeons (ACS), stated that “The public would be shocked if it knew the amount of unnecessary surgery performed.” [The New York Times, February 17, 1953]. More than twenty years later, in 1976, the American Medical Association (AMA) called for a congressional hearing on unnecessary surgery, claiming that there were “2.4 million unnecessary operations performed on Americans at a cost of $3.9 billion and that 11,900 patients had died from unneeded operations.” [The New York Times, May 12, 1976]. In the 21st century, unnecessary medical treatment remains a daunting reality that continues to expose patients to an unjustified risk for sustaining preventable harm.

This month’s featured article reports on a mixed methods analysis designed to identify potential cases of unnecessary invasive procedures performed between 2008 to 2016. The authors identified 79 reports of which more than half involved > 30 patients and about one third involved > 100 patients. While the root cause of those unnecessary procedures remains elusive, a pragmatic argument would support the notion that procedures performed in spite of contrary evidence related to a lack of benefit for patients are performed for the following main reasons: (1) a lack of knowledge by providers about the current evidence in the field; (2) knowledge of evidence but disagreement by practicing providers; (3) knowledge of evidence with blatant disregard, likely due to prestige, personal or monetary incentives. The current study sheds some further light into a poorly understood and publicly under-recognized entity that may have a significant impact as a contributor of preventable patient harm in the 21st century.