Beyond the operating room: Adverse events and outcomes after colorectal surgery

Clinical outcome measures, including length of stay and mortality, are indicative of the quality and safety of care provided to hospitalized patients. Adverse events demonstrate opportunities to improve quality and safety and thus clinical outcomes. We sought to investigate the impact of adverse events on patient outcomes in colorectal surgery patients.

A retrospective analysis of colorectal patients captured in the National Surgical Quality Improvement Program from January to December 2024 in a large, urban hospital was completed. Adverse events were defined as postoperative events in the National Surgical Quality Improvement Program and validated events identified by the Pascal Metrics Risk Trigger Monitoring program. Adverse events were categorized, and associations between adverse event categories and patient outcomes were investigated. The performance of the National Surgical Quality Improvement Program and Pascal in identifying adverse events and their association with outcomes was compared.

Of the 298 patients, 40.9% had ≥1 adverse event reported (n = 122), with 4.2 events on average per case. Patients with reported adverse events had 15.4 times higher mortality (P < .01). The number of adverse events was positively associated with length of stay (Spearman, 0.61; P < .01). National Surgical Quality Improvement Program and Pascal identified different adverse events for the same patient in 61.5% of cases. The National Surgical Quality Improvement Program identified most procedure/surgery-related events and nosocomial infections, whereas Pascal excelled in patient care and safety and medication-related events.

When using 2 rigorous complementary adverse event-reporting mechanisms, colorectal surgery patients have a high incidence of adverse events (40.9%). The number of adverse events was significantly associated with longer length of stay and mortality (P < .01). The use of complementary adverse event identification systems is essential to comprehensively identify adverse events and assess their associated outcomes.