Evaluating preventable adverse safety events after elective lower extremity procedures

Area of Science:

• Vascular Surgery
• Patient Safety
• Health Services Research

Background:

• Patient safety is a national priority, with Patient Safety Indicators (PSIs) used to identify preventable adverse events.
• No prior studies have evaluated PSIs in lower extremity (LE) vascular procedures.

Purpose of the Study:

• To evaluate the occurrence of PSIs in elective lower extremity angioplasty (endo) versus bypass (open) procedures.
• To identify predictors and outcomes associated with PSIs in LE vascular interventions.

Main Methods:

• Analysis of the Nationwide Inpatient Sample (2003-2007) for 226,501 elective LE interventions (104,491 endo, 122,010 open).
• Statistical analysis using chi-squared and logistic regression to assess PSI rates, predictors, and outcomes.

Main Results:

• Overall PSI rates were 7.74% for open and 8.51% for endovascular procedures (P < .0001).
• Postoperative hemorrhage/hematoma (PSI9) was a predominant PSI in endovascular cases, associated with a threefold increase in mortality.
• Predictors of PSIs included advanced age, female sex, black race, congestive heart failure, diabetes, renal failure, teaching hospital status, and larger hospital size.
• PSIs significantly increased costs ($28,387 vs $13,278; P < .0001).

Conclusions:

• Endovascular procedures had lower mortality but higher PSI rates, mainly due to bleeding in women and the elderly.
• PSIs are linked to demographic factors (age, race) and comorbidities.
• Adverse events increase healthcare costs and are more prevalent in teaching and large hospitals, suggesting a need for organizational analysis to improve safety and reduce costs.