Preoperative Signing of the Incision Site in Orthopaedic Surgery in Canada

Wrong-site surgery is an often catastrophic yet preventable problem. Reports of wrong-site surgery have been on the rise in the United States every year since 19951,2. The number of reported cases has increased from sixteen in 1998 to fifty-eight at the time of writing in 2001. Eleven cases occurred in the month of November 2001 alone1,2. These increases are cause for grave concern. Wrong-site surgery is a concern for every surgical specialty. However, orthopaedic surgery has an inherently higher risk compared with other types of surgery. Orthopaedic surgeons frequently operate on extremities, and many diseases do not have ob-vious external abnormalities. Of the 126 reported cases of wrong-site surgery in the United States, 41% were orthopaedic-related procedures1,2. Operating on the correct site can be ensured through a strict series of checks and rechecks involving the surgeons, nurses, residents, and patients. In 1994, the Canadian Orthopaedic Association (COA) began an educational program intended to prevent such mistakes from occurring. Their recommendations included marking the incision site with a permanent marker prior to entering the operating room3. The rates of wrong-site surgery in orthopaedic procedures in Canada have been declining since 1987 ( Fig. 1 ). Since 1994, the number of cases has been reduced from thirteen cases per year to five cases per year in 20004. Most of the cases involved knee surgery, and, in all but one, the knee had not been marked4. Fig. 1: Graph showing the number of reported occurrences of wrong-site surgery per year in Canada. (Data provided by the Canadian Medical Protective Association.) The purpose of this study was to evaluate the impact that the campaign to promote preoperative signing of the incision site had on Canadian orthopaedic surgeons by …