Disclosure of complications

[leviathan]

When mistakes happen during a surgery that don't lead to any complications after, do they have to be disclosed? When I was doing a CT surg rotation last year I think I was in a lung biopsy when the attending hit the pulmonary artery and we lost about 1000cc of blood into the chest. He repaired the problem and the patient did well, so is there still either an ethical or legal obligation to tell the patient in a case like this?

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[LucidSplash]

IMHO, if the patient was appropriately consented prior to the procedure, "significant bleeding and damage to surrounding structures" should have been included in the list of known risks; practically any surgery that enters the thoracic cavity (or the abdominal cavity for that matter) involves an inherent risk of injury to major vascular structures. After the procedure the patient should have been told by his surgeon that the team encountered significant bleeding which required transfusion (I assume here that the patient received blood products during this incident) but that the source was repaired satisfactorily and that the surgeon expected no further issues.

 

[leviathan]

If the patient was appropriately consented prior to the procedure, "significant bleeding and damage to surrounding structures" should have been included in the list of known risks; practically any surgery that enters the thoracic cavity (or the abdominal cavity for that matter) involves an inherent risk of injury to major vascular structures. After the procedure the patient should have been told by his surgeon that the team encountered significant bleeding which required transfusion (I assume here that the patient received blood products during this incident) but which was able to be repaired satisfactorily.

Blood was ordered but the attending got hemostasis well before it ever made its way down to the OR, and we never ended up using it. He may have received some post-operatively, but I wasn't following him after. If there was a transfusion of course you are obliged to disclose that fact and why it was done, but if no transfusion was given, then that makes me wonder.

 

[LucidSplash]

I think everything still stands as I wrote. Patients always ask how it went and I would just say "there was some significant bleeding but we were able to get it under control and repair the source without incident." All this hinges on whether or not the patient was consented properly. What you are describing in a known and established risk of this kind of surgery, not really a major event that you need to get into graphic detail about in the PACU. The events were, presumably, appropriately noted in the op note but otherwise, unless the patient grills you for an anatomy lesson, most will be satisfied with "some bleeding, we stopped it, you did or didn't need blood."

 

[leviathan]

I think everything still stands as I wrote. Patients always ask how it went and I would just say "there was some significant bleeding but we were able to get it under control and repair the source without incident." All this hinges on whether or not the patient was consented properly. What you are describing in a known and established risk of this kind of surgery, not really a major event that you need to get into graphic detail about in the PACU. The events were, presumably, appropriately noted in the op note but otherwise, unless the patient grills you for an anatomy lesson, most will be satisfied with "some bleeding, we stopped it, you did or didn't need blood."

Fair enough. Thanks!

 

[ESU_MD]

Most surgeons would "disclose" this event. I would tell the family we lost some blood, the tumor was stuck, etc. If you make a big deal about something like this, then the family/ pt gets all suspicious. Its better just to tell them something upfront. Theres always some nurse advocate out there who will try to notify the family 2 weeks later, then it makes you look guilty.

 

[Buzz Me]

That's not really a "complication," per se. Not in the same way that a post-op DVT is.