Incidence, nature and impact of error in surgery

Bosma, Eelke; Veen, Eelco J.; Roukema, Jan A.

doi:10.1002/bjs.7594

Cited by 41 publications

(31 citation statements)

References 29 publications

(29 reference statements)

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“…Increasing public scrutiny of the quality of care provided by hospitals has prompted studies of the documentation, management, and prevention of complications [1-3]. In that context, safety and quality have become prominent criteria in the evaluation of surgical care.…”

Section: Introductionmentioning

confidence: 99%

Hospital costs associated with surgical morbidity after elective colorectal procedures: a retrospective observational cohort study in 530 patients

Zoucas

Lydrup

2014

Patient Saf Surg

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BackgroundPostoperative complications contribute to morbidity and mortality. This study assessed the impact of surgical complications on healthcare resource utilization for patients undergoing elective colorectal procedures.MethodData were obtained on 530 consecutive colorectal operations performed from January 2010 to January 2011. Patient demographics, type of procedure, surgical complications classified as Clavien 1–5, length of stay, 60-day readmission rate, and hospital costs were recorded.ResultsSeventy-five percent of the operations were associated with malignancy, and 26% were pelvic procedures. Thirty-five percent of the patients developed at least one complication, 21% of the complications did not require intervention. The readmission rate was 7.4%. Nine patients died during 60-day post discharge follow up.Median length of stay was 9 (3–34) days in uncomplicated and 16 (4–205) days in complicated cases. Occurrence of any complication at index admission increased total hospital costs 2.1-fold (EUR 25,680 vs. EUR 12,405), with the largest cost differential attributed to wound dehiscence and/or suture line failure requiring reoperation. These increases were primarily due to prolonged hospitalization and ICU expenditures. Readmission resulted in a further increase to an average cost of EUR 12,585 per re-admitted patient.Multivariate analysis showed that BMI > 25, obesity, operation complexity and surgeon significantly affected the risk for complication. Also, hospital costs were significantly increased by any postoperative complications, reoperations, high complexity of surgical procedures and high comorbidity index.ConclusionsReducing morbidity after colorectal procedures improves quality of care and patient safety, and may also substantially reduce hospital costs and increase the efficiency of resource utilization.

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Section: Introductionmentioning

confidence: 99%

Hospital costs associated with surgical morbidity after elective colorectal procedures: a retrospective observational cohort study in 530 patients

Zoucas

Lydrup

2014

Patient Saf Surg

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“…3 In surgery, there is a lack of a clear definition and grading system to classify negative outcome, which hampers the interpretation of results. 5 Considerable resources have been invested in measuring and reducing the rates of SAEs. The phrase surgical adverse events (SAEs) therefore better describes any deviation from the normal postoperative course that reflects safety in health care delivery.…”

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confidence: 99%

Systematic Review of the Impact of Surgical Harm on Quality of Life After General and Gastrointestinal Surgery

et al. 2014

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“…However, studies have shown that errors called near misses are common and that preventing them will, in the long run, reduce the incidence of error-related complications. 10,27,33 Our study is one of the few that has assessed the effect of error recording and/or reporting on the pattern of error in medical practice in general and the first in neurosurgery in particular. Many available error studies have reported only the incidence and pattern of medical errors and adverse events.…”

Section: Resultsmentioning

confidence: 99%

A reduction in errors is associated with prospectively recording them

Oremakinde

Bernstein

2014

JNS

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Object Error recording and monitoring is an important component of error prevention and quality assurance in the health sector given the huge impact of medical errors on the well-being of patients and the financial loss incurred by health institutions. With this in mind, assessing the effect of reporting errors should be a cause worth pursuing. The object in this study was to examine the null hypothesis that recording and publishing errors do not affect error patterns in a clinical practice. Methods Intraoperative errors and their characteristics were prospectively recorded between May 2000 and May 2013 in the neurosurgical practice of the senior author (M.B.). The error pattern observed between May 2000 and August 2006, which has been previously described (Group A), was compared with the error pattern observed between September 2006 and May 2013 (Group B). Results A total of 1108 cases in Group A and 974 cases in Group B were surgically treated. A total of 2684 errors were recorded in Group A, while 1892 errors were recorded in Group B. The ratios of cranial to spinal procedures performed in Groups A and B were 3:1 and 10:1, respectively, while the ratios of general to local anesthesia in the two groups were 2:1 and 1.3:1, respectively (p < 0.0001 for both). There was a significantly decreased proportion of cases with error (87% to 83%, p < 0.006), mean errors per case (2.4 to 1.9, p < 0.0001), proportion of error-related complications (16.7% to 5.5%, p < 0.002), and clinical impacts of error (2.7% to 1.0%, p < 0.0001) in Group B compared with Group A. Errors in Group B tended to be more preventable than those in Group A (85.8% vs 78.5%, p < 0.0001). A significant reduction was also noticed with most types of error. A descending trend in the mean errors per case was demonstrated from the years 2001 to 2012; however, an increased severity of errors (22.6% to 29.5%, p < 0.0001) was recorded in Group B compared with Group A. Conclusions Data in this study showed that the act of recording errors might alter behaviors, resulting in fewer errors.

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Incidence, nature and impact of error in surgery

Abstract: This study shows that errors are common in surgery, and that near misses are more frequent than errors with serious consequences. It is hypothesized that registration of near misses might prevent errors with serious consequences and thus improve quality of care.

Cited by 41 publications

References 29 publications

Hospital costs associated with surgical morbidity after elective colorectal procedures: a retrospective observational cohort study in 530 patients

Hospital costs associated with surgical morbidity after elective colorectal procedures: a retrospective observational cohort study in 530 patients

Systematic Review of the Impact of Surgical Harm on Quality of Life After General and Gastrointestinal Surgery

A reduction in errors is associated with prospectively recording them

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