Misadventures to patients during surgical and medical care in England and Wales: an analysis of deaths and hospital episodes

Abstract

SummaryObjectives To estimate incidence of injury to patients attributed to misadventures during surgical and medical care by age group and to examine recent trends.Design Analysis of routine morbidity and mortality data categorized by the 9th and 10th revisions of the International Classification of Diseases.Participants Children 0-14 years and adults ≥15 years. Setting England and Wales during 1999 to 2008 (hospital episodes) and 1979 to 2009 (deaths).Main outcome measures We calculated deaths per million personyears and per 1000 hospital episodes; hospital episodes per 100,000 person-years and per 100,000 procedures performed.Results The rate of death attributed to misadventures during surgical and medical care in patients aged 75 years and older was over 50 times (rate ratio 57.2; 95% confidence interval 38.3 -85.3) higher than in children aged 1-14 years. Estimated hospital episode rates were 20 times (RR 20.0; 18.9 -21.2) higher in patients aged 75 years and older. Mortality attributed to misadventures declined from 1.1 (0.9 -1.4) deaths per million personyears in 1979 to 0.4 (0.2 -0.6) in 2009. Hospital episodes of misadventures decreased between 1999 and 2008 from 30.8 (29.9 -31.8) episodes per 100,000 procedures to 23.25 (22.5-24

A national overview of surgical misadventures in head and neck surgery: “Oh No, You Cut It”

“…3 Nonetheless, the accidental nature of such injuries renders even one event singularly disquieting. An intraoperative unintentional injury could result in significant harm and mortality, 3,4 and could potentially affect the surgeon and hospital reputation and develop into malpractice litigation. 1,5 The complex anatomy of the head and neck region and the proximity of multiple vital structures make most surgical interventions carry an inherent risk of accidental injury of nearby structures, such as the facial nerve, recurrent laryngeal nerve, thoracic duct, salivary duct, sigmoid sinus, tegmen, jugular bulb, and carotid artery.…”

“…Nonetheless, the accidental nature of such injuries renders even one event singularly disquieting. An intraoperative unintentional injury could result in significant harm and mortality, and could potentially affect the surgeon and hospital reputation and develop into malpractice litigation …”