Annals of the Royal College of Surgeons of England
-
Doctors are exhorted to be candid with their patients when clinical errors occur. This paper discusses the history of candour in surgical law as well as recommendations resulting from the Mid Staffordshire public inquiry. It also looks at why candour is necessary and where the threshold should lie. Provided surgeons understand that a duty of candour is engaged at a certain threshold of harm, then disclosure of misadventure to patients or their relatives becomes simply a matter for clinical judgement, just in the same way as a surgeon judges which potential operative complications need to be disclosed during the consenting process.
-
Ann R Coll Surg Engl · Sep 2014
The incidence of postoperative urinary retention in patients undergoing elective hip and knee arthroplasty.
Postoperative urinary retention requiring urethral catheterisation increases the risk of joint sepsis following arthroplasty. Spinal anaesthesia with opiate administration is used widely in lower limb arthroplasty. We sought to establish whether the choice of opiate agent had any effect on the incidence of postoperative retention and therefore the risk of joint sepsis. ⋯ Urinary retention was observed in 14% of male and 2% of female patients with GA+FNB, 9% of male and 3% of female patients with SA+ITF, and 60% of male (p=0.0005) and 5% of female patients with SA+ITM. Men who experienced retention were older (68 vs 64 years, p=0.013) and had longer inpatient stays (6.7 vs 4.6 days, p=0.043). Fewer patients in the SA+ITM group required breakthrough analgesia (28% vs 58%, p=0.004). Concusions: The use of ITM in men significantly increases the incidence of urinary retention requiring urethral catheterisation and subsequently increases the risk of deep joint sepsis. Its use should be rationalised against the intended benefits and alternatives sought where possible.
-
Ann R Coll Surg Engl · Sep 2014
Case ReportsAn unusual place to find a lost needle in laparoscopic surgery.
Losing a needle during laparoscopic surgery is an uncommon but potentially challenging scenario for the surgeon. The prolonged operative time to search for a small retained foreign body such as a needle can cause clinical and medicolegal complications. As a result, it is considered a 'never event'. This report describes a case of a lost needle during a laparoscopic prostatectomy, when a meticulous and systematic search for the foreign body was initiated and completed with the use of x-rays, only to find it in an unusual place.
-
Ann R Coll Surg Engl · Sep 2014
Case ReportsIsolated proximal rupture of flexor digitorum longus tendon in a traumatic open subtalar dislocation.
Tendon ruptures associated with ankle fractures and dislocations or subtalar dislocations are very rare entities with only a few reports of these in the literature. We report a case of an open subtalar dislocation and associated isolated proximal rupture of the flexor digitorum longus tendon at the musculotendinous junction, following a relatively low energy trauma. ⋯ The patient has made a good functional recovery from his injuries. This case is reported because of the rarity of this combination of injuries and the associated management dilemma with which it presented us.
-
Ann R Coll Surg Engl · Sep 2014
Selective non-operative management of penetrating liver injuries at a UK tertiary referral centre.
Selective non-operative management (SNOM) of penetrating abdominal injuries has increasingly been applied in North America in the last decade. However, there is less acceptance of SNOM among UK surgeons and there are limited data on UK practice. We aimed to review our management of penetrating liver injuries and, specifically, the application of SNOM. ⋯ SNOM is a safe strategy for patients with penetrating liver injuries in a UK setting. Patient selection is critical and CT is a vital triage tool. Arterial phase contrast extravasation may predict failure of SNOM and adjunctive angioembolisation should be considered for this group.