The measurement and monitoring of surgical adverse events

Abstract

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Rates of surgical site infection as a performance measure: Are we ready?

“…Since the 1990s, increasing interest has been placed in the incorporation of clinical adverse events as quality indicators in hospital quality assurance programs [5] . Adverse postoperative events, and very specially SSI rates after specific procedures, gained popularity as hospital quality indicators in the 1980s [13,14] , and are currently some of the most widely used hospital quality indicators worldwide [5,[15][16][17] .…”

“…Since the 1990s, increasing interest has been placed in the incorporation of clinical adverse events as quality indicators in hospital quality assurance programs [5] . Adverse postoperative events, and very specially SSI rates after specific procedures, gained popularity as hospital quality indicators in the 1980s [13,14] , and are currently some of the most widely used hospital quality indicators worldwide [5,[15][16][17] . Other outcomes or processes frequently proposed as measures of quality in surgical care include postoperative mortality, postoperative long-term survival, postoperative functional status and health-related quality of life, other postoperative morbidity (e.g.…”

“…Similarly, although the concept of measuring and monitoring adverse events that arise in hospitalized patients as direct or indirect consequence of medical assistance was initiated more than three decades ago [3] , the term "adverse event" only gained popularity and substance since 1991, with the publication of the shocking Harvard Medical Practice Study I (HMPS-I) by Brennan et al [4] . This was the very first, large-scaled study to measure and quantify with scientific accuracy the prevalence of adverse events and medical negligence in hospitalized patients [4,5] . In the HMPS-I study, over 30 000 medical records of non-psychiatric patients discharged from 51 acute care hospitals in New York State in 1984 were randomly sampled and reviewed for evidence of adverse events and negligence [4] .…”

“…Other outcomes or processes frequently proposed as measures of quality in surgical care include postoperative mortality, postoperative long-term survival, postoperative functional status and health-related quality of life, other postoperative morbidity (e.g. anastomotic leak, deep vein thrombosis), patient satisfaction, postoperative length of stay, costs, and access [5,18] . Robust evidence shows that programs for continuous quality improvement in surgical care, based on the measurement and monitoring of outcome-based and process-based quality indicators, with periodic feedback to providers and managers, can be very effective in reducing post-operative complications, patient mortality, and costs [19][20][21][22] .…”

Standardizing endpoints in perioperative research

“…A review of surgical adverse events in 2001 found 41 different definitions and 13 grading scales for surgical-site infections among the 82 studies included in the review. 30 The recent debate regarding definitions of perioperative myocardial injury is likewise ongoing. 31,32 Even seemingly simple binary constructs such as mortality may be presented in a variety of ways.…”