Common complications in orthopaedic surgery

Surgical complications are defined as ‘any undesirable, unintended, and direct result of an operation affecting the patient that would not have occurred had the operation gone as well as could reasonably be hoped’ (Sokol and Wilson, 2008). Surgical complications can be categorised as intraoperative or postoperative, depending if the complications occur during or after the surgical procedure. A postoperative complication includes any event that occurs within a 30-day period after the surgery, either during or after hospitalisation (Jacobs er al 2007). Complications can also be categorised as patient-related and practitioner-related. Practitioner-related complications are often a result of a surgical error; however, not all surgical errors end up in surgical complications.

It remains key that errors and complications be recognised, identified and managed timely. The objective of recognising these errors and complications is to be able to anticipate and implement measures to prevent them as much as possible (Tseis et al 2014; Wooley et al 1993). A key strategy to decrease the risk of complications is to ask the members of the team the questions: ‘Are we ready to respond?’.

Morbidity and mortality discussions provide analysis of failures and were first implemented in the early 1900s at Massachusetts General Hospital (USA). Implementation of Morbidity and Mortality discussions have led to improved healthcare quality and patient safety (Kravet et al, 2006; Lecoanet et al, 2016; Tignanelli et al, 2017).

Professional practice evaluations by peer review of physician individuals and groups lead to improved quality, protected patients from harm and improved patient outcome through implementation of measures to identify and prevent operative complications. (Reines et al 2017; Tignanelli et al 2017). Implementation of surgical safely checklists improved surgical safety of human patients, but reduced morbidity, reduced hospitalisations, reduced mortality, whilst maintained operating room efficiently (Gawande 2007).

Unprofessional behaviour within the surgical theatre is associated with 14% higher surgical complication rate (Tschan et al 2019) and disruptive doctors have a negative impact on the work of members of the surgical team, with team members making more mistakes in the operating room.

Examples of surgical errors and complications in equine orthopaedic surgery will be reviewed in this lecture.