Moje Christine, Jackson Terri J, McNair Peter
Victorian Department of Human Services, Melbourne, VIC, Australia.
Aust Health Rev. 2006 Aug;30(3):333-43. doi: 10.1071/ah060333.
To investigate a method to identify and understand patterns of adverse events by utilising secondary data analysis; to identify the types of complications associated with elective surgery; to identify any specific "adverse event-prone" elective procedures; and to consider the implications of these patterns for hospital patient safety programs.
Public hospitals in Victoria.
Secondary analysis of data on acute hospital admissions for elective surgery in the period 1 July 2000 to 30 June 2001, for non-obstetric patients older than 15 years (n = 177 533).
Estimated rates of adverse events for the most commonly performed elective surgery procedures; frequency of the most commonly recorded adverse event types.
Of all admissions, 15.5% had at least one complication of care. The most frequent first-recorded single complication code, in 9.6% of cases with a complication, was "Haemorrhage and haematoma complicating a procedure". The most common adverse event categories were cardiac and circulatory complications (23%), symptomatic complications (18%), and surgical and drug-related complications (17%). The procedure blocks most frequently associated with an adverse event were coronary artery bypass surgery (67%), colectomy (52%), hip and knee arthroplasty (42% and 36%, respectively), and hysterectomy (20%). The types of complications associated with the four most adverse event-prone procedures were cardiac arrhythmias, surgical adverse events (haemorrhage or laceration), intestinal obstruction, anaemia, and symptomatic complications.
Routinely collected data are valuable in obtaining information on complication types associated with elective surgery. International Classification of Diseases codes and surgical procedure "blocks" allow very sophisticated investigation of types of complications and differences in complication rates for different surgical approaches. The usefulness of such data relies on good documentation in the medical record, thorough coding and periodic data audit. The limitations of the method described here include the lack of follow-up after discharge, variable coding standards between institutions and over time (potentially distorting information on rates), lack of information on the causative factors for some adverse events, and a limited capacity to support investigation of particular cases. Hospitals should consider monitoring complication rates for individual elective procedures or blocks of similar procedures, and comparing adverse event rates over time and with peer hospitals as an integral part of their patient safety programs.
通过二次数据分析研究一种识别和理解不良事件模式的方法；确定与择期手术相关的并发症类型；识别任何特定的“易发生不良事件”的择期手术；并考虑这些模式对医院患者安全计划的影响。
维多利亚州的公立医院。
对2000年7月1日至2001年6月30日期间15岁以上非产科患者择期手术急性住院数据进行二次分析（n = 177533）。
最常见的择期手术的不良事件估计发生率；最常记录的不良事件类型的频率。
在所有入院患者中，15.5%至少发生了一种护理并发症。在9.6%有并发症的病例中，首次记录的最常见单一并发症编码是“手术中出血和血肿”。最常见的不良事件类别是心脏和循环系统并发症（23%）、症状性并发症（18%）以及手术和药物相关并发症（17%）。与不良事件最常相关的手术分组是冠状动脉搭桥手术（67%）、结肠切除术（52%）、髋关节和膝关节置换术（分别为42%和36%）以及子宫切除术（20%）。与四种最易发生不良事件手术相关的并发症类型是心律失常、手术不良事件（出血或撕裂）、肠梗阻、贫血和症状性并发症。
常规收集的数据对于获取与择期手术相关的并发症类型信息很有价值。国际疾病分类编码和手术“分组”允许对并发症类型以及不同手术方法的并发症发生率差异进行非常精细的调查。此类数据的有用性依赖于病历中的良好记录、全面编码和定期数据审核。此处描述的方法的局限性包括出院后缺乏随访、不同机构之间以及随时间变化的编码标准不一致（可能扭曲发生率信息）、缺乏某些不良事件的致病因素信息以及支持特定病例调查的能力有限。医院应考虑监测个别择期手术或类似手术分组的并发症发生率，并随着时间推移以及与同侪医院比较不良事件发生率，将其作为患者安全计划的一个组成部分。
