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Surgical technology and operating-room safety failures: a systematic review of quantitative studies
  1. Ruwan A Weerakkody1,2,
  2. Nicholas J Cheshire1,2,
  3. Celia Riga1,2,
  4. Rachael Lear1,
  5. Mohammed S Hamady1,
  6. Krishna Moorthy1,
  7. Ara W Darzi1,
  8. Charles Vincent3,
  9. Colin D Bicknell1,2
  1. 1Department of Surgery and Cancer, Imperial College London, London, UK
  2. 2Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, UK
  3. 3Clinical Safety Research Unit, Imperial College, London, UK
  1. Correspondence to Colin D Bicknell, Vascular Secretaries Office, Praed Street, London W2 1NY, UK; colin.bicknell{at}


Background Surgical technology has led to significant improvements in patient outcomes. However, failures in equipment and technology are implicated in surgical errors and adverse events. We aim to determine the proportion and characteristics of equipment-related error in the operating room (OR) to further improve quality of care.

Methods A systematic review of the published literature yielded 19 362 search results relating to errors and adverse events occurring in the OR, from which 124 quantitative error studies were selected for full-text review and 28 were finally selected.

Results Median total errors per procedure in independently-observed prospective studies were 15.5, interquartile range (IQR) 2.0–17.8. Failures of equipment/technology accounted for a median 23.5% (IQR 15.0%–34.1%) of total error. The median number of equipment problems per procedure was 0.9 (IQR 0.3–3.6). From eight studies, subdivision of equipment failures was possible into: equipment availability (37.3%), configuration and settings (43.4%) and direct malfunctioning (33.5%). Observed error rates varied widely with study design and with type of operation: those with a greater burden of technology/equipment tended to show higher equipment-related error rates. Checklists (or similar interventions) reduced equipment error by mean 48.6% (and 60.7% in three studies using specific equipment checklists).

Conclusions Equipment-related failures form a substantial proportion of all error occurring in the OR. Those procedures that rely more heavily on technology may bear a higher proportion of equipment-related error. There is clear benefit in the use of preoperative checklist-based systems. We propose the adoption of an equipment check, which may be incorporated into the current WHO checklist.

  • Safety culture
  • Checklists
  • Patient safety
  • Healthcare quality improvement
  • Surgery

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