Impact of intraoperative adverse events in general and gastrointestinal surgery: A nationwide study

Intraoperative adverse events (iAEs) during general surgery can lead to significant morbidity and healthcare burden, yet their impact remains underexplored. We aimed to estimate the nationwide incidence of iAEs in general surgery and explore their associations with mortality, complications, length of stay, and costs.

We conducted a retrospective cohort study using the Nationwide Readmissions Database 2019 and included adult patients (aged 18 years and older) who underwent general surgical procedures. Eligible patients were grouped based on the presence of an iAE, defined as an unrecognized abdominopelvic accidental puncture or laceration. The primary outcome was in-hospital mortality, while secondary outcomes included 30-day post-operative complications, length of stay, and total inpatient costs. Multivariable logistic and linear regression models were used to examine the association between the presence of an iAE and post-operative outcomes and costs.

A total of 701,866 patients were included. The mean age was 55.1 years, and 60.0 ​% were female. 6350 (0.9 ​%) experienced an iAE. The procedure with the highest incidence of iAE was small bowel resection (2.3 ​%). On univariate analysis, patients who experienced an iAE had higher mortality (3.8 ​% vs. 1.5 ​%, P ​< ​0.001), 30-day complications, length of stay, and inpatient costs. After multivariable regression, iAEs were independently associated with an increase in in-hospital mortality, length of stay, unplanned readmission, wound complications, acute kidney injury, sepsis, surgical site infection, ileus, and inpatient costs.

Despite their low incidence, iAEs are associated with heightened rates of complications and healthcare utilization. Incorporating iAEs into surgical quality initiatives and developing iAE reporting standards is warranted.