Characterization of safety of inpatient care in surgical settings

1. Adverse events were identified in more than one third of patients admitted to hospital for surgery, nearly half of which were classified as major adverse events and most potentially preventable.

2. The most common adverse events were associated with surgical procedures, followed by adverse drug events, healthcare-associated infections, and patient care events. 

Evidence Rating Level: 2 (Good)

Adverse events during hospital admission significantly contribute to patient harm. The landmark Harvard Medical Practice Study conducted in the 1980s revealed that nearly half of the estimated incidence and preventability of adverse events during hospital care were linked with surgical procedures. Since this study, patient safety and surgical care have transformed substantially over the past decades. To ensure ongoing quality improvement in surgical care, this study aimed to provide an updated evaluation of surgical safety by estimating the incidence, severity, and preventability of adverse events during perioperative care for surgical patients. This retrospective cohort study included a random sample of 64,121 patients from 11 hospitals admitted for surgery in 2018. Adverse events were defined as unintended physical injury resulting from or contributed to by medical care that required additional monitoring, treatment, or hospital admission, or that resulted in death. Major adverse events were defined as serious, life-threatening, or fatal. All records were reviewed by trained nurses and adjudicated by physicians for the occurrence of adverse events. In total, 1,009 patients were included in a weighted random sample (mean age = 60.9 years, 95% CI 60.0 to 61.7; 519 (51.4%) female). Among the 1009 patients analyzed, at least one adverse event occurred in 383 (38.0%) (95% confidence interval (CI) 32.6 to 43.4) and at least one major adverse event occurred in 160 (15.9%) (95% CI 12.7 to 19.0). Of the 593 identified adverse events, 353 (59.5%) were potentially preventable and 123 (20.7%) were definitely or probably preventable. The most common adverse events were associated with surgical procedures (n = 292, 49.3%), followed by adverse drug events (n = 158, 26.6%), healthcare-associated infections (n = 74, 12.4%), patient care events (n = 66, 11.2%), and blood transfusion reactions (n = 3, 0.5%). Compared to adverse drug and patient care events, surgery-related adverse events were more likely to be rated as major adverse events and less likely to be preventable. Adverse events were most common in general care units (n = 289, 48.8%), followed by operating rooms (n = 155, 26.1%), intensive care units (n = 77, 13.0%), recovery rooms (n = 20, 3.3%), emergency departments (n = 11, 1.8%), and other in-hospital locations (n = 42, 7.0%). Professions most involved were attending physicians (n = 531, 89.5%), followed by nurses (n = 349, 58.9%), residents (n = 294, 49.5%), advanced level practitioners (n = 169, 28.5%), and fellows (n = 68, 11.5%). Overall, this study revealed that adverse events are still frequent and preventable in surgery. Study findings highlight the urgent need for continuous improvement in patient safety that involves all health professionals throughout perioperative care.

Click to read the study in BMJ

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