Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Department of Dermatology, University of Pennsylvania Health System, Philadelphia, Pennsylvania.
J Am Acad Dermatol. 2016 Jun;74(6):1185-93. doi: 10.1016/j.jaad.2015.12.019. Epub 2016 Feb 4.
Biopsy site identification is critical to avoid wrong-site surgery and may impact patient-centered outcomes.
We sought to evaluate risk factors for biopsy site misidentification, postponement of surgery, and patient confidence in surgical site selection and to assess the near-miss rate for wrong-site surgeries.
This was a prospective observational cohort study.
Near-miss wrong-site surgeries were detected and averted in 1.3% (3 of 239) of patients with biopsy site photographs. Risk factors for biopsy site misidentification by patients were 6 weeks or longer between biopsy and surgery (odds ratio [OR] 2.19, 95% confidence interval [CI] 1.12-4.27; P = .028) and patient inability to see biopsy site (OR 3.95, 95% CI 1.50-10.37; P = .002). Risk factors for physician misidentification were 6 or more weeks between biopsy and surgery (OR 3.68, 95% CI 1.40-9.66; P = .007) and biopsy specimens from multiple sites (OR 4.39, 95% CI 1.67-11.54; P = .003). Postponement of surgery was associated with absence of a biopsy site photograph (OR 12.5, 95% CI 2.79-62.21; P < .001). Patient confidence in surgical site identification was associated with the presence of a biopsy site photograph (OR 5.48, 95% CI 1.96-15.30; P = .001).
This was a single-site observational study.
Biopsy site photography is associated with reduced rates of postponed surgeries and improved rates of patient confidence in surgical site selection. Risk factors for biopsy site misidentification should be considered before definitive treatment.
活检部位的识别对于避免错误部位手术至关重要，并且可能会影响以患者为中心的治疗结果。
我们旨在评估活检部位识别错误、手术推迟以及患者对手术部位选择的信心的风险因素，并评估错误部位手术的接近错误率。
这是一项前瞻性观察性队列研究。
在接受活检部位拍照的 239 例患者中，发现并避免了 1.3%（3 例）的接近错误部位手术。患者活检部位识别错误的风险因素是活检与手术之间的时间间隔为 6 周或更长时间（优势比[OR] 2.19，95%置信区间[CI] 1.12-4.27；P=.028）和患者无法看到活检部位（OR 3.95，95% CI 1.50-10.37；P=.002）。医生识别错误的风险因素是活检与手术之间的时间间隔为 6 周或更长时间（OR 3.68，95% CI 1.40-9.66；P=.007）和活检标本来自多个部位（OR 4.39，95% CI 1.67-11.54；P=.003）。手术推迟与缺乏活检部位照片有关（OR 12.5，95% CI 2.79-62.21；P<.001）。患者对手术部位识别的信心与活检部位照片的存在有关（OR 5.48，95% CI 1.96-15.30；P=.001）。
这是一项单站点观察性研究。
活检部位拍照可降低手术推迟的发生率，并提高患者对手术部位选择的信心。在进行确定性治疗之前，应考虑活检部位识别错误的风险因素。
