Study finds high rates of preventable, adverse events in perioperative care

Editor's Note

Adverse events (AEs) remain widespread in perioperative care, affecting nearly one in three patients and resulting in substantial and often preventable patient harm, according to a retrospective cohort study published November 13 in The BMJ.

The study analyzed 1,009 weighted admissions from a sample of 64,121 surgical patients discharged in 2018 from 11 hospitals in Massachusetts. Researchers focused the incidence, severity, and preventability of AEs.

Key findings include:

• AEs were identified in 38% of surgical admissions.
• Major AEs (serious, life-threatening, or fatal) occurred in 15.9%.
• Fatal AEs were rare (0.6%), but serious or life-threatening events comprised 14.2%.
• 25.6% of patients experienced potentially preventable AEs.
• 10.2% of AEs were classified as probably or definitively preventable.
• Among major AEs, 15.6% were deemed probably or definitely preventable.
• Surgical-related events dominated (49.3%), followed by adverse drug events (26.6%), healthcare-associated infections (12.4%), and patient care events such as falls or pressure ulcers (11.2%). These AEs were less likely to be preventable but more likely to be severe compared to other categories.
• AEs occurred most frequently in general care units (48.8%) and operating rooms (26.1%).
• Physicians were implicated in 89.5% of cases, followed by nurses (58.9%) and residents (49.5%).
• Older patients and those undergoing cardiovascular and thoracic procedures were at higher risk of experiencing AEs.

The findings highlight the need for targeted strategies to improve surgical outcomes, researchers write, including dynamic monitoring, interdisciplinary collaboration, and enhanced safety protocols across the perioperative continuum.