Department of Surgery, Massachusetts General Hospital, Boston.
Department of Surgery, Massachusetts General Hospital, Boston.
Surgery. 2018 Sep;164(3):525-529. doi: 10.1016/j.surg.2018.04.035. Epub 2018 Jun 24.
The true incidence of intraoperative adverse events (iAEs) remains unknown.
All patients undergoing abdominal surgery at an academic institution between January and July 2016 were included in a prospective fashion. At the end of surgery, using a secure REDCap database, the surgeon was given the Institute of Medicine definition of intraoperative adverse events and asked whether an intraoperative adverse event had occurred. Blinded reviewers systematically examined all operative reports for intraoperative adverse events and their severity. The response rate and the intraoperative adverse event rate reported by surgeons were calculated. The latter was compared with the rate of intraoperative adverse events detected by operative report review. The severity of intraoperative adverse events was assessed based on a previously validated intraoperative adverse event classification system.
A total of 1,989 operations were included. The surgeons' response rate was 71.9%, reporting intraoperative adverse events in 107 operations (7.5%). Of those intraoperative adverse events, 26 (24.3%) were not described in the operative report. Operative report review revealed intraoperative adverse events in 417 operations (21.0%). Most injuries were of lower severity (85.8% were either class I or II). The surgeons' response rate was similar in operations with and without intraoperative adverse events (69.8% versus 72.5%, P=.28), but they underreported low severity intraoperative adverse events-only 13.2% of class I compared with 35.3%, 36.8%, and 55.6% of injury classes II, III, and IV respectively (P<.001).
Surgeons are willing to report intraoperative adverse events, but systematically and significantly underreport them, especially if they are of lower severity. This is potentially related to the absence of a clear intraoperative adverse event definition or their personal interpretation of their clinical significance.
术中不良事件（iAEs）的真实发生率尚不清楚。
2016 年 1 月至 7 月期间，采用前瞻性方法纳入在学术机构接受腹部手术的所有患者。手术结束时，外科医生使用安全的 REDCap 数据库获得医学研究所（IOM）对术中不良事件的定义，并被问及是否发生术中不良事件。盲法审核员系统地检查所有手术报告以确定术中不良事件及其严重程度。计算外科医生报告的术中不良事件发生率和反应率。并将外科医生报告的术中不良事件发生率与手术报告审核中检测到的术中不良事件发生率进行比较。术中不良事件的严重程度基于先前验证的术中不良事件分类系统进行评估。
共纳入 1989 例手术。外科医生的反应率为 71.9%，报告了 107 例手术（7.5%）中的术中不良事件。在这些术中不良事件中，有 26 例（24.3%）在手术报告中未描述。手术报告审核发现 417 例手术（21.0%）中有术中不良事件。大多数损伤的严重程度较低（85.8%为 I 级或 II 级）。有术中不良事件和无术中不良事件的手术中，外科医生的反应率相似（69.8%与 72.5%，P=.28），但他们对低严重程度的术中不良事件报告不足——仅报告了 13.2%的 I 级损伤，而分别有 35.3%、36.8%和 55.6%的 II 级、III 级和 IV 级损伤（P<.001）。
外科医生愿意报告术中不良事件，但系统且显著地报告不足，尤其是如果事件严重程度较低。这可能与缺乏明确的术中不良事件定义或他们对其临床意义的个人解释有关。
