Letter in reference to the article “Surgery on the wrong side: Implication for the patient and the professional. Experience in a Major Ambulatory Surgery of the Foot Unit”

Sir,

We read with interest the article “Surgery on the wrong side: Implication for the patient and the professional. Experience in a Major Ambulatory Surgery of the Foot Unit” by Asuncion Márquez J., López Gutiérrez A., Pérez Martínez V., et al., published in issue 2, volume 56, of the Spanish Journal of Orthopaedic Surgery and Traumatology (Revista Española de Cirugía Ortopédica y Traumatología).¹ We wish to congratulate the authors for their work and for highlighting an often overlooked problem.

We also wish to insist, as we have done on other occasions, that the definition “wrong-site surgery” would be more adequate than “wrong-side surgery”.^2,3 The concept of “wrong-site surgery” encompasses both surgery performed on the wrong side of the body and that conducted in a wrong location (such as an elbow instead of a wrist, even if they are on the same side of body). It also includes surgery performed on a wrong patient and surgery conducted with a different procedure than that originally planned and for which the patient has given his consent (such as performing knee prosthesis instead of arthroscopy).

The translation of “site” is “sitio” and the translation of “sitio” is “site”. The different protocols mentioned in this article (AAOS, CAO, JCAHO, etc.) refer to “wrong-site surgery”, so it does not seem correct to translate this as “wrong-side surgery” as has been done throughout the entire article. Discussing surgery on the wrong side limits the concept and this term does not encompass other dimensions of the problem. In the study by Meimberg and Stern cited by the authors, the most common mistake was to operate on a different finger than planned in the same hand. This could hardly be defined as an error of “side”.⁴

One of the most common mistakes of this kind in orthopaedic surgery is operating at the wrong level in spinal surgery. Once again, this does not seem to fit in the concept of “wrong-side surgery”, whereas it is included within the more generic concept of “wrong-site surgery”.

Even the title of the English translation of the summary of the article published in the Journal refers to “surgery on the wrong side” and the abstract refers to “surgery of the wrong side”, rather than “wrong-site surgery”, which is the generally accepted term to describe the problem.

Therefore, we support the Spanish translation of “wrong-site surgery” as “cirugia en sitio erroneo”. On the other hand, we wish to emphasise that the crucial point is to increase awareness of this issue among orthopaedic surgeons and to establish clearly defined methods which aid in preventing this error.