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

To examine a representative case series of surgical adverse events in New Zealand public hospitals with a view to assessing their occurrence, causation, patient impact and preventability.

An analysis was carried out on 326 surgical adverse events classified by reviewing physicians. These were identified from among 850 adverse events determined by two-stage retrospective review of a representative sample of 6579 medical records drawn from 13 public hospitals in 1998.

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. Four-fifths 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%).

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.