complications in shoulder surgery and how to avoid them

Lennard Funk

Complications How to Avoid Them

lenfunk@shoulderdoc.co.uk

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“The more I see The more I know The more I know The less I understand”

Paul Weller

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!Common sense is not as common as we think !Majority of complications come from bad Decisions

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Decision Making

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Daniel Kahneman, Amos Tversky (2000). Choice, Values, Frames. Cambridge University Press. ISBN 0-521-62172-0.

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Funky Fives

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Funk’s Rule of Fives for Unfavourable Outcome

1. Five Complaints

2. Five Opinions

3. Five months wait for surgery

4. Five Procedures

5. Five Follow-ups

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Five General Tips

1. Practice on Models & Cadavers

2. Write the procedure down & describe it aloud • ALWAYS have a Plan B for every step

3. Perform first 3 with senior colleague

4. If you think it is easy, you will make mistakes • Unaware

• Even on your 100th case!

5. Visit other surgeons regularly

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Five Technical Tips

1. Use as many portals as needed

2. Release-release-release

3. Use cannula wherever possible

1. If not - ‘Virtual Cannula’

4. Two sutures per cannula at any one time

5. Tie through the same hole as the anchor

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Five things you should never say:

1. “That will do”

2. “I think I can make it better”

1. Enemy of ‘Perfect’ is ‘Good’

3. “Oops”

4. “I can’t remember how I did it last time”

5. “I wouldn’t have done it like that”“

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AAOS Medical Liability Committee

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“Arthroscopic surgery can be a safe, minimally invasive way to address joint pathology. !!Despite its efficacy, however, complications may occur.!!Proper training and care are required to minimize complications. !!When complications do occur, it is vital that the surgeon maximize communication with the patient to explain what occurred, how it will be handled, and what the impact might be on the expected outcome.”

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Takeaway Message

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When making any decision, ask yourself WHY you are making that decision. What are your driving factors?

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