Representative case series from public hospital admissions 1998 II: surgical adverse events

Results. From the four surgical categories—operative, fracture management, therapeutic, and system—there were 326 surgical adverse events, 38.4% of all adverse events identified. Surgical events had the same profile as adverse events overall. Fourfifths of surgical events were directly related to a surgical operation; these affected older patients and were less preventable than adverse events overall. A third of operative events were attributable to technical problems, another third to infections, with the remainder divided between haemorrhagic and cardiovascular complications. Therapeutic and system events had high preventability, and a significant proportion was related to delay in treatment. Half of events in fracture management were infection-related, patients were younger and, system events apart, had fewer extra bed days than other surgical events or events overall. The major causes of preventable events were avoidable delay in treatment (19.9%) and inadequate monitoring and supervision (13.6%), followed by personnel practising outside their expertise (8.0%) and inappropriate treatment (7.4%). Conclusions. On average, surgical events are associated with an extra 9.9 days in hospital, but they have a lower level of preventability than adverse events overall. Problems of infection, delay, and other aspects of the quality of care are identified for further consideration. Adverse events in surgical practice in hospitals are common, are costly, and are a considerable burden. In a review of adverse events occurring in Colorado and Utah hospitals, 60% of such incidents (and more than 12% of hospital deaths) were associated with surgical care. 1 The impact of these events on patients was high, with nearly one in seven resulting in permanent disability or death. A comparable study of adverse events in hospitals in South Australia and New South Wales had similar findings, with 51% of such incidents associated with surgical care, and one in six resulting in permanent disability or death. 2 Both studies also demonstrated that half or more of adverse events related to surgical care were preventable.