Abstract
I read with interest the report on hazards associated with caring for the morbidly obese patients in the operating room (OR), as it relates to the equipment that we utilize to care for these patients. 1 I applaud the authors for shining additional light on the topic patient obesity and safety issues, especially as it relates to patient falls in the OR. An anesthetized or sedated patient on a surgical or procedural table does not have the ability to anticipate or avoid a fall from height nor do they have the reflexes to protect themselves during a fall. Vital organs, most notably the brain, can be at risk during a fall from height from a surgical table. While an awake patient would instinctively anticipate or avoid a fall or take measures to protect their head in the event of a fall, an anesthetized patient loses that ability to intervene. For this reason, falls in the OR often lead to devastating injuries and even deaths in severe circumstances. Having experienced a few near-miss falls several years ago, it caused me to take a special interest in the topic.2,3 While delivering lectures focused on patient falls in the OR across the country in a variety of settings, it has become clear to me that falls in the OR occur far more frequently than most people realize. Following the lectures, attendees have frequently shared their own harrowing stories of falls and near-misses that have occurred but have never been reported in the literature.
The scenario reminds me of the topic of OR fires about 2 decades ago. Prior to united efforts by major patient safety organizations to educate OR personnel on the topic of fire safety, it seemed to be a topic that many had experienced, but the lessons learned were not widely distributed due to the stigma associated with such a complication. Similarly, in my experience, most experienced OR personnel have knowledge of patient falls or near-misses, frequently associated with obesity issues, as discussed by the authors. Most commonly in the stories that I have heard, major contributing factors include OR table failure or tipping related to exceeding table limits, wear and tear of the equipment related to the stress of patient weight, unusual patient positioning demands, and failure of or inattention to locking mechanisms on the stretchers during patient transfer.
It is my hope that the authors’ report will shine additional light on this topic that appears to be greatly underreported in the medical literature. Indeed, most major textbooks in anesthesiology or surgery have no mention of patient falls in the operating room as a possible complication related to surgery and anesthesia. I believe that it will require a concerted effort among anesthesiologists, surgeons, and nursing personnel along with surgery/anesthesiology safety organizations to make patient fall risk a part of the daily conversations in all cases performed in the OR. I believe that there is a growing recognition of the problem and this manuscript moves us one step closer to the issue coming to the forefront so that it can be discussed more openly, allowing the vigilance of all team members to be unified. We must be able to openly share our experiences so that others can benefit from the lessons that we all have learned. Only in this way can we decrease the risk of patient falls in the OR and procedural suites.
