Meeuwis M A, de Jongh M A C, Roukema J A, van der Heijden F H W M, Verhofstad M H J
Department of Surgery, St. Elisabeth Hospital, P.O. Box 90151, 5000 LC, Tilburg, The Netherlands.
Trauma Centre Brabant, St. Elisabeth Hospital, P.O. Box 90151, 5000 LC, Tilburg, The Netherlands.
Arch Orthop Trauma Surg. 2016 Feb;136(2):185-93. doi: 10.1007/s00402-015-2377-5. Epub 2015 Dec 21.
Adverse events and associated morbidity and subsequent costs receive increasing attention in clinical practice and research. As opposed to complications, errors are not described or analysed in literature on fracture surgery. The aim of this study was to provide a description of errors and complications in relation to fracture surgery, as well as the circumstances in which they occur, for example urgency, type of surgeon, and type of fracture.
All errors and complications were recorded prospectively in our hospital's complication registry, which forms an integral part of the electronic medical patient file. All recorded errors and complications in the complication registry linked to fracture surgery between 1 January, 2000 and 31 December, 2010 were analysed.
During the study period 4310 osteosynthesis procedures were performed. In 78 (1.8 %) procedures an error in osteosynthesis was registered. The number of procedures in which an error occurred was significantly lower (OR = 0.53; p = 0.007) when an orthopaedic trauma surgeon was part of the operating team. Of all 3758 patients who were admitted to the surgical ward for osteosynthesis, 745 (19.8 %) had one or more postoperative complications registered. There was no significant difference in the number of postoperative complications after osteosynthesis procedures in which an orthopaedic trauma surgeon was present or absent (16.7 vs. 19.1 %; p = 0.088; OR 0.85).
In the present study the true error rate after osteosynthesis may have been higher than the rate found. Errors that had no significant consequence may be especially susceptible to underreporting.
The present study suggests that an osteosynthesis procedure performed by or actively assisted by an orthopaedic trauma surgeon decreases the probability of an error in osteosynthesis. Apart from errors in osteosynthesis, the involvement of an orthopaedic trauma surgeon did not lead to a significant reduction in the number of postoperative complications.
不良事件及其相关的发病率和后续成本在临床实践和研究中受到越来越多的关注。与并发症不同，骨折手术文献中并未对错误进行描述或分析。本研究的目的是描述与骨折手术相关的错误和并发症，以及它们发生的情况，例如紧急程度、外科医生类型和骨折类型。
所有错误和并发症均前瞻性地记录在我院的并发症登记册中，该登记册是电子医疗患者档案的一个组成部分。对2000年1月1日至2010年12月31日期间并发症登记册中与骨折手术相关的所有记录的错误和并发症进行分析。
在研究期间共进行了4310例骨固定手术。在78例（1.8%）手术中记录到骨固定错误。当骨科创伤外科医生参与手术团队时，发生错误的手术数量显著降低（比值比=0.53；p=0.007）。在因骨固定手术入住外科病房的所有3758例患者中，745例（19.8%）记录有一项或多项术后并发症。骨科创伤外科医生参与或未参与的骨固定手术后，术后并发症数量无显著差异（16.7%对vs, 19.1%； p=0.088；比值比0.85）。
在本研究中，骨固定后的实际错误率可能高于所发现的比率。没有重大后果的错误可能特别容易漏报。
本研究表明，由骨科创伤外科医生进行或积极协助的骨固定手术可降低骨固定错误的概率。除骨固定错误外，骨科创伤外科医生的参与并未导致术后并发症数量显著减少。
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