From the Department of Orthopedic Surgery, University of Missouri, Columbia, MO (Dr. Belzarena), and the Sarcoma Department, Moffitt Cancer Center, Tampa, FL (Dr. Binitie, Dr. Letson, and Dr. Joyce).
J Am Acad Orthop Surg Glob Res Rev. 2024 Jan 22;8(1). doi: 10.5435/JAAOSGlobal-D-23-00176. eCollection 2024 Jan 1.
Soft-tissue sarcomas present as a mass with nonspecific symptoms, and unplanned excisions commonly occur. The purpose of this study was to analyze the incidence of unplanned excisions performed by orthopaedic surgeons and to conduct a root cause analysis (RCA) of the steps that led to unplanned excisions in all the cases.
A retrospective case-control study was conducted. Two cohorts were identified, one including patients who underwent an unplanned excision of a soft-tissue sarcoma (n = 107) and a second cohort with patients whose entire care was performed at our sarcoma center (n = 102). A RCA was conducted with the whole sample to identify the preventable causes that led to sarcoma unplanned excisions.
Orthopedic surgeons were the second group of physicians to perform the most unplanned excisions, only behind general surgeons. Inadequate imaging was encountered in 76.6% of the patients (n = 82, 95% confidence interval, 67.8 to 83.6). Forty-five patients (42.1%) had no imaging studies before the unplanned procedure. In the RCA, the most notable obstacles found were (1) incorrect assumption of a benign diagnosis, (2) failure to obtain the appropriate imaging study, (3) incorrectly reported imaging studies, (4) failure to order a biopsy, and (5) incorrect reporting of the biopsy.
Despite educational efforts, unplanned excisions and the devastating consequences that sometimes follow continue to occur. Orthopaedic surgeons persist in playing a role in the unplanned procedure burden.
软组织肉瘤表现为肿块伴非特异性症状，常发生计划外切除。本研究旨在分析骨科医生行计划外切除的发生率，并对所有病例导致计划外切除的步骤进行根本原因分析（RCA）。
回顾性病例对照研究。确定了两个队列，一个队列包括软组织肉瘤行计划外切除的患者（n=107），另一个队列包括在我们肉瘤中心接受全程治疗的患者（n=102）。对整个样本进行 RCA，以确定导致肉瘤计划外切除的可预防原因。
骨科医生是行计划外切除第二多的医生，仅次于普外科医生。76.6%（n=82，95%置信区间，67.8%至83.6%）的患者遇到了不充分的影像学检查。45 名患者（42.1%）在计划外手术前没有进行影像学检查。在 RCA 中，发现的最显著障碍包括：（1）错误地假设良性诊断，（2）未能获得适当的影像学检查，（3）错误报告的影像学检查，（4）未能进行活检，以及（5）活检报告不正确。
尽管进行了教育，但计划外切除以及随后可能发生的破坏性后果仍在继续发生。骨科医生仍然在计划外手术负担中发挥作用。
