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Patient Safety in the Operating Room: I. Preoperative

Poore, Samuel O. M.D., Ph.D.; Sillah, Nyama M. M.D.; Mahajan, Ashish Y. M.D.; Gutowski, Karol A. M.D.

doi: 10.1097/PRS.0b013e31826945d6
Reconstructive: Trunk: Special Topics
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Background: Beyond the controlled trauma of surgery, the operating room can be a hazardous place for patients and health care workers alike. Modern plastic surgery requires a thorough knowledge of various perioperative risks and methods to minimize these risks. As the importance of teamwork becomes more evident, clear communication skills preoperatively, intraoperatively, and postoperatively become equally critical. To facilitate an improvement in perioperative patient safety, this article will review aspects of communication, including crew resource management, root cause analysis, and surgical-site verification. In addition, the authors will discuss patient positioning, antiseptic hand and patient preparations, and barriers, such as surgical scrubs, gowns, gloves, and drapes.

Methods: The authors reviewed the literature regarding operating room safety, both primary research and secondary reviews, via multiple PubMed queries and literature searches. Topics most relevant to inpatient plastic surgery were included in the final analysis and summarized, as a full review of each topic is beyond the scope of this article.

Results: Many possible interventions were identified, with the goal of reducing perioperative complications, such as wrong site surgery, neuropathies, myopathies, compartment syndromes, pressure ulcers, surgical-site infections, and blood-borne disease transmissions among plastic surgeons and their patients.

Conclusions: There are ample opportunities for the reduction of preventable adverse events in plastic surgery. This article aims to provide its reader with the tools to research adverse events and a basic education in avoiding specific preoperative events. A second article addressing intraoperative and postoperative patient safety follows.

Madison, Wis.; Wilkes-Barre, Pa.; and Glenview, Ill.

From the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Wisconsin; Plastic and Reconstructive Surgery, Geisinger Wyoming Valley; and private practice.

Received for publication February 1, 2012; accepted May 25, 2012.

Disclosure: The authors have no financial interests to declare. No funding was obtained or utilized for the research and writing of this article.

Samuel O. Poore, M.D., Ph.D.; University of Wisconsin Department of Surgery, Division of Plastic and Reconstructive Surgery, 600 Highland Avenue, CSC G5/361, Madison, Wis. 53792-3236,

©2012American Society of Plastic Surgeons