Massachusetts: Study finds adverse event rates during surgery can be as high as 38%

A study of 11 hospitals in Massachusetts showed that the rate of adverse events during surgery was as high as 38%, and nearly half of them were serious. Despite technological and procedural advances in surgical safety since 1991, these preventable injuries persist, indicating an urgent need for stronger safety measures and patient engagement in healthcare practice. A new study published in The BMJ shows that more than a third (38%) of adults will experience an adverse event while undergoing surgery, based on data from 11 hospitals in Massachusetts. Of the 1,009 admissions analyzed, nearly half of the adverse events were classified as major events, involving serious, life-threatening or fatal injuries, most of which were considered preventable.

The researchers said that while the study may not fully reflect the situation in all hospitals, the findings highlight that "adverse events remain prevalent in contemporary health care, causing substantial, preventable harm to patients during hospital admissions."

Adverse events – negative effects of treatments such as medicines or surgeries – pose a significant risk to patient safety and are a leading cause of harm in hospitals.

Since the 1991 Harvard Medical Practice Study revealed the extent of unintended harm caused by medical care, surgical care has undergone tremendous changes, such as increased use of minimally invasive surgery, implementation of surgical safety checklists, and enhanced postoperative recovery programs.

However, an up-to-date assessment of surgical safety is needed to establish precise reference points for continuous quality improvement.

Therefore, the researchers set out to estimate the frequency, severity, and preventability of adverse events associated with perioperative care (from before surgery to full recovery) and to describe the relevant settings and specialties.

Their findings are based on a random sample of 1,009 patients aged 18 and older who underwent surgery at 11 Massachusetts hospitals in 2018. The hospitals were chosen to represent a mix of large and small practices across three different health systems, and the estimates were weighted to account for differences in the sample populations.

Trained nurses review all records and flag admissions for possible adverse events, which are then adjudicated by physicians. Adverse events are classified as major if they result in serious harm, require major intervention or prolonged recovery, involve life-threatening events, or result in death.

The severity and preventability of adverse events were also assessed based on the type of event, setting, and profession involved.

Impact and prevention of adverse events in surgery

Of the 1009 hospitalized patients reviewed (mean age, 61 years; 52% women), adverse events were observed in 383 (38%) of whom were major (16%).

Of the 593 adverse events identified, 353 (60%) were potentially preventable and 123 (21%) were definitely or probably preventable.

The most common adverse events were related to the surgical procedure (49%), followed by adverse drug events (27%), nosocomial infections (12%), patient care events such as falls or pressure ulcers (11%), and transfusion reactions (0.5%).

Half of these incidents occurred in general care units, followed by operating rooms (26%), intensive care units (13%), and other hospital settings (7%). The most commonly implicated occupation was attending physician (90%), followed by nurses (59%), residents (50%), and advanced practice physicians (29%).

These are observational findings, and the authors acknowledge that their analysis was limited to Massachusetts in 2018, so may not apply to other healthcare settings, and that they rely on the accuracy of electronic health record data.

Furthermore, some events that are considered preventable today may not have been considered preventable when care was initially provided.

“By establishing an up-to-date reference point, this study demonstrates that adverse events remain pervasive in contemporary health care, causing substantial, preventable harm to patients during hospital admissions,” they wrote. “This problem extends beyond surgeons in the operating room to health care specialties throughout the hospital during perioperative care, suggesting a need to reevaluate how the structure of health care contributes to these ongoing challenges.”

Editorial on Patient Safety

In a linked editorial, Helen Haskell, president of Mothers Against Medical Error, asked: Why hasn't patient safety improved over the years?

Possible reasons include a culture of disrespect, insufficient nurse staffing, and a failure to leverage existing technology to detect and prevent adverse events in real time.

Haskell says all of this undoubtedly plays a role, but she believes little progress has been made in involving patients and families in uncovering the causes and impacts of care errors: “If we are truly interested in promoting patient safety, we must empower patients and families to weigh in on whether their care records are accurate and to participate in finding solutions.”

From Chinese Information Network