Feature Story

Surgery-related errors may adversely affect up to 3 percent of hospitalized patients

Surgery-related errors (adverse events) can result in patient death, disability, or a prolonged hospital stay. A new study shows that surgery-related errors adversely affected about 3 percent of patients admitted to hospitals in Colorado and Utah in 1992. How much the incidence of adverse events varies regionally is unknown, but this could represent a decline from previous incidence rates of 3.7 percent of New York admissions in 1984 and 4.6 percent of California hospital admissions in 1972.

In Utah and Colorado, two-thirds of all adverse hospital events were surgical, and nearly one in seven resulted in permanent disability or death. Furthermore, more than half of these were preventable, according to the study, which was supported in part by the Agency for Health Care Policy and Research (National Research Service Award training grant T32 HS00020).

Complications related to surgical technique, wound infections, and postoperative bleeding produced nearly half of all surgical adverse events; one-fourth of complications were related solely to surgical technique. Adverse events related to nonoperative aspects of care provided to surgical patients proved surprisingly important as well. Drug-related errors, diagnostic errors, and errors in choice of therapy accounted for 12 percent of surgical patients' adverse events.

Researchers led by Atul A. Gawande, M.D., of Brigham and Women's Hospital, reviewed the records of 15,000 nonpsychiatric hospital discharges in 1992 from a representative sample of hospitals from Utah and Colorado. They identified 12 operations with significantly elevated adverse event incidence rates that ranged from 4.4 percent for hysterectomy to 18.9 percent for abdominal aortic aneurysm repair. It was not clear why some operations resulted in high rates of injury. Further research is needed to identify strategies that will effectively reduce surgical adverse events.

For more details, see "The incidence and nature of surgical adverse events in Colorado and Utah in 1992," by Dr. Gawande, Eric J. Thomas, M.D., M.P.H., Michael J. Zinner, M.D., and Troyen A. Brennan, M.D., J.D., M.P.H., in the July 1999 Surgery 126(1), pp. 66-75.

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