Medical Errors and Complications in Neurointervention: Underreported and Underestimated? A Systematic Review

Medical errors and complications (MEAC) in neurointervention have important implications for patient safety and health care costs, with 50% of patient harm due to medical errors being preventable. Despite this, literature on MEAC in the outpatient setting is scarce.

The aim of this systematic review is to summarize current evidence regarding MEAC in neurointervention, focusing on the outpatient setting.

We conducted a systematic review of PubMed/MEDLINE in adherence to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and identified studies on neurointerventional complications published from 2004 to 2024.

Eligible studies were original research articles that reported on medical errors or complications, stratified by care phase: prehospital, in-hospital nonprocedural, procedural, and postdischarge.

Data extraction included demographic characteristics, time points, types of errors and complications, follow-up methods, and reporting practices. Descriptive statistics and unadjusted logistic regression were used to analyze the data.

From 174 studies involving 60,812 patients, we observed a total complication rate of 17.2%. Most studies reported on in-hospital procedural complications in their data (83.3%), whereas only 1.7% and 31.6% addressed prehospital and postdischarge complications, respectively. Systematic patient follow-up significantly increased the likelihood of identifying postdischarge complications (OR 2.16; 95% CI, 1.06-4.40). Severe adverse events dominated postdischarge reports, highlighting a possible gap in documenting minor complications and medical errors, particularly in outpatient settings.

Complication assessment and reporting are not standardized in the field of neurointervention, which has likely led to heterogeneity and publication bias in our results. The search strategy did not identify studies that did not overtly mention complications or medical errors in the title or abstract, which may have biased the search to some degree. Complication frequency may change over time with improving techniques, and there is thus a potential for overestimation of complication rates in earlier studies compared with today's everyday neurointerventional practice.

Neurointerventional literature primarily focuses on in-hospital, procedure-related events, whereas only a few studies on prehospital and postdischarge errors and complications are available. Standardized tools, such as patient-reported outcome measures, and rigorous follow-up protocols are critical for comprehensive complication reporting. Establishing quality standards for complication documentation would facilitate improved patient care and enable systematic comparisons across studies.