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The Prevalence of Wrong Level Surgery Among Spine Surgeons

Mody, Milan G., MD; Nourbakhsh, Ali, MD; Stahl, Daniel L., MD; Gibbs, Mark, MD; Alfawareh, Mohammad, MD; Garges, Kim J., MD

doi: 10.1097/BRS.0b013e31816043d1
Health Services Research
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Study Design. A questionnaire study.

Objective. To evaluate the prevalence of wrong level surgery among spine surgeons and their use of preventive measures to avoid its occurrence.

Summary of Background Data. Wrong site surgery fails to improve the patient's symptoms and has medical, emotional, social, and legal implications. Organizations such as the North American Spine Society and the Joint Commission on Accreditation of Healthcare Organizations have established guidelines to prevent wrong site surgery. Spine surgeons' compliance with these guidelines and the prevalence of wrong-level spine surgery have not been investigated previously.

Methods. All members of the American Academy of Neurologic Surgeons (n = 3505) were sent an anonymous, 30-question survey with a self-addressed stamped envelope.

Results. A total of 415 (12%) surgeons responded. Sixty-four surgeons (15%) reported that, at least once, they had prepared the incorrect spine level, but noticed the mistake before making the incision. Two hundred seven (50%) reported that they had done 1 or more wrong level surgeries during their career. From an estimated 1,300,000 spine procedures, 418 wrong level spine operations had been performed, with a prevalence of 1 in 3110 procedures. The majority of the incorrect level procedures were performed on the lumbar region (71%), followed by the cervical (21%), and the thoracic (8%) regions. One wrong level surgery led to permanent disability, and 73 cases resulted in legal action or monetary settlement to the patient (17%).

Conclusion. There is a high prevalence of wrong level surgery among spine surgeons; 1 of every 2 spine surgeons may perform a wrong level surgery during his or her career. Although all spine surgeons surveyed report using at least 1 preventive action, the following measures are highly recommended but inconsistently adopted: direct preoperative communication with the patient by the surgeon, marking of the intended site, and the use of intraoperative verification radiograph.

The authors conducted a questionnaire study to evaluate the prevalence of wrong level spine surgery. From an estimated 1,300,000 procedures, 418 wrong level operations were performed, with a prevalence of 1 in 3110. To prevent wrong level surgery, the authors recommend direct preoperative communication between patient and surgeon, marking of the site, and the use of intraoperative verification radiograph.

From the Division of Spine Surgery, Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, TX.

Acknowledgment date: April 12, 2007. Revision date: June 8, 2007. Acceptance date: July 5, 2007.

The manuscript submitted does not contain information about medical device(s)/drug(s).

Institutional funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Address correspondence and reprint requests to Kim Garges, MD, Division of Spine Surgery, Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, TX; E-mail: kjgarges@utmb.edu

© 2008 Lippincott Williams & Wilkins, Inc.