Retained surgical items (RSI) are a never event, yet they continue to happen. This commentary summarizes recent changes to an existing guidance that defines a range of retained devices or products to coalesce with industry terminology. The author shares steps to reduce the potential for RSI retention. 

While prior research has described malpractice cases related to breast cancer diagnosis and treatment, this study sought to identify errors specifically related to breast cancer surgical procedures. Plastic surgeons were the most commonly named provider type (64%), error in surgical treatment was the most common allegation (87%), and infection, cosmetic injury, emotional trauma, foreign body, and nosocomial infection were the top 5 injury descriptions.

The perioperative setting is a high-risk environment. This continuing education model discusses safety threats and evidence-based best practices to deliver nursing care in perioperative settings and promote a culture of safety.

Prior research suggests that patients undergoing surgery at night are at greater risk for intraoperative adverse events. This retrospective cohort study including over 350,000 adult patients undergoing non-cardiac surgery found that night surgery was associated with an increased risk of postoperative mortality and morbidity. The effect was mediated by potentially preventable factors, including higher blood transfusion rates and more frequent provider handovers.

This thematic analysis identified 123 events comprising malpractice claims in the closed claims database of the American Association of Nurse Anesthetists (AANA) Foundation that the investigators determined could have been prevented by the Certified Registered Nurse Anesthetist involved. Among the factors identified as being associated with preventable events were communication failures, violations of the AANA Standards for Nurse Anesthesia Practice, and errors in judgment.

Office-based anesthesia (OBA) is being performed more commonly internationally. This narrative literature review updates the evidence related to the safety of OBA and makes recommendations for safe practices including; medical directors to be responsible for evidence-based policies, OBA safety and patient checklists emergency procedures, physical setting requirements, pharmacological management, preoperative procedures, airway management and others. The authors identify that lack of consistent regulations and incomplete protocol standardization is problematic.

Collecting real-time audio, video, and system data enables identification of process vulnerabilities. This commentary discusses the current state of black box approaches to collect surgical procedure data in situ and highlights challenges to its effective use and implementation to improve surgical safety.

The overprescribing of opioids for postsurgery pain can increase the potential for opioid dependence, misuse, and harm. Discussing this worldwide patient safety concern, this commentary summarizes clinician, patient, and systemic factors that contribute to the problem and outlines efforts to address the issue while enabling clinicians to provide safe pain therapy to patients.

Potential deterioration of older surgeons' technical performance is a patient safety concern. This guidance developed from a Society of Surgical Chairs panel discussion puts forth several steps to manage the transition of aging surgeons. Recommendations include mandatory cognitive and psychomotor testing for surgeons age 65 and older, respectful consideration of the financial and emotional concerns of aging surgeons, and lifelong mentoring around the transition from clinical to nonclinical roles. The authors anticipate that such initiatives will prompt thoughtful support for aging surgeons that ensures patient safety. In an accompanying editorial, an older physician supports mandatory testing and suggests individual-level steps to address aging as a surgeon, including healthy lifestyle and financial habits.

The FDA recently raised awareness of the potential risks associated with the use of robotic-assisted surgical devices in mastectomies or cancer-related care. This commentary spotlights how payers, hospitals, and clinicians can prevent harm related to robotic surgical device use. Strategies to improve safety include enhanced credentialing, device-specific training, and informed consent. A WebM&M commentary discussed an incident of harm associated with robotic-assisted surgery.

Safe medication use can be challenging in ambulatory surgery centers. This commentary reviews strategies to improve safety in this setting, including close collaboration with a pharmacist or pharmacy, assessing medication management, and providing clinician education.

Prior research has shown that certain surgeon behaviors are associated with an increased risk of malpractice claims, but less is known about how certain patient factors such as sleep may impact patients' desire to pursue litigation and seek financial compensation. In this study, researchers randomized healthy adults to normal sleep and sleep-restriction. After 4 nights, participants read and rated eight medical error vignettes. Sleep restriction was associated with increased desire to punish the surgeons and provide greater financial compensation to the patients described in the vignettes.

This commentary explores how gaps in legal and regulatory structure affect anesthesia medication safety. The author advocates for use of a public health law framework to prevent certain types of perioperative medication errors made by anesthesiologists. Policy approaches that require organizations to provide prefilled syringes and barcoding scanners are suggested to avoid vial- and syringe-related mistakes.

Scheduling overlapping surgeries has raised substantial patient safety concerns. However, research regarding the impact of concurrent surgery on patient outcomes has produced conflicting results. In this multicenter retrospective cohort study, researchers examined the relationship between overlapping surgery and mortality, postoperative complications, and surgery duration for 66,430 surgeries between January 2010 and May 2018. Although overlapping surgery was not significantly associated with an increase in mortality or complications overall, researchers did find a significant association between overlapping surgery and increased length of surgery. An accompanying editorial discusses the role of overlapping surgery in promoting the autonomy of those in surgical training and suggests that further research is needed to settle the debate regarding the impact of overlapping surgery on patient safety.

Closed claim analysis can identify care problems and inform improvement strategies. This review examined closed claims for anesthesia and identified types of injuries experienced by patients receiving anesthesia. Situational awareness, distractions, equipment problems, and pain medicine complications contributed to anesthesia malpractice claims.

This pre–post study found that implementation of relative value unit–based payment in a head and neck surgery practice resulted in a higher volume of procedures. The incidence of adverse outcomes, including postoperative hospitalizations, infections, unplanned return surgeries, and emergency department visits, did not change. The authors conclude that the change in payment structure did not impact surgical safety.

This systematic review of the safety of overlapping surgery included 14 studies and did not find differences in 30-day mortality or overall morbidity in overlapping versus nonoverlapping surgery across a range of procedures. Researchers noted a small increase in length of procedure for overlapping surgeries. They conclude that overlapping surgery does not lead to higher risk for morbidity and mortality, despite the controversy associated with this practice.

This retrospective review of National Surgical Quality Improvement Program data on hospital-acquired conditions following elective spine surgery found that 3% of these cases had at least one hospital-acquired condition. The most common conditions were surgical site infection, followed by urinary tract infection and venous thromboembolism, all well-recognized conditions with known evidence-based prevention strategies.