Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Harvard T.H. Chan School of Public Health, Boston, MA 02120, USA
Research on Healthcare Performance RESHAPE, Inserm U1290, Université Claude Bernard Lyon 1, Lyon, France.
BMJ. 2024 Nov 13;387:e080480. doi: 10.1136/bmj-2024-080480.
To estimate the frequency, severity, and preventability of adverse events associated with perioperative care, and to describe the setting and professions concerned.
Multicenter retrospective cohort study.
11 US hospitals.
1009 patients from a randomly selected sample of 64 121 adults admitted for surgery during 2018.
Adverse events during inpatient perioperative care were assessed using a trigger method, identifying information previously associated with similar events, and from a comprehensive review of electronic health records. Trained nurses reviewed all records and flagged admissions with possible adverse events, which were then adjudicated by physicians, who confirmed the occurrence and characteristics of the events. Adverse events were classified as major if they resulted in serious harm requiring substantial intervention or prolonged recovery, involved a life threatening event, or led to a fatal outcome. Potentially preventable events included those definitively, probably, or possibly preventable.
Among 1009 patients reviewed, adverse events were identified in 38.0% (95% confidence interval 32.6 to 43.4), with major adverse events occurring in 15.9% (12.7 to 19.0). Of 593 identified adverse events, 353 (59.5%) were potentially preventable and 123 (20.7%) were definitely or probably preventable. The most common adverse events were related to surgical procedures (n=292, 49.3%), followed by adverse drug events (n=158, 26.6%), healthcare associated infections (n=74, 12.4%), patient care events (n=66, 11.2%), and blood transfusion reactions (n=3, 0.5%). Adverse events were most frequent in general care units (n=289, 48.8%), followed by operating rooms (n=155, 26.1%), intensive care units (n=77, 13.0%), recovery rooms (n=20, 3.3%), emergency departments (n=11, 1.8%), and other in-hospital locations (n=42, 7.0%). Professions most involved were attending physicians (n=531, 89.5%), followed by nurses (n=349, 58.9%), residents (n=294, 49.5%), advanced level practitioners (n=169, 28.5%), and fellows (n=68, 11.5%).
Adverse events were identified in more than one third of patients admitted to hospital for surgery, with nearly half of the events classified as major and most potentially preventable. These findings emphasize the critical need for ongoing improvement in patient safety, involving all health professionals, throughout perioperative care.
评估与围手术期护理相关的不良事件的频率、严重程度和可预防程度，并描述相关的环境和专业人员。
多中心回顾性队列研究。
美国 11 家医院。
2018 年期间随机抽取的 64121 名成年人中 1009 名接受手术的患者。
使用触发方法评估住院围手术期护理期间的不良事件，该方法识别先前与类似事件相关的信息，并对电子病历进行全面审查。经过培训的护士审查了所有记录，并标记出可能发生不良事件的入院患者，然后由医生进行裁决，医生确认事件的发生和特征。如果不良事件导致严重伤害需要大量干预或延长康复、涉及危及生命的事件或导致致命后果，则将其归类为主要不良事件。潜在可预防的事件包括明确、可能或可能可预防的事件。
在审查的 1009 名患者中，38.0%（95%置信区间 32.6 至 43.4）发生了不良事件，其中 15.9%（12.7 至 19.0）发生了主要不良事件。在 593 例确定的不良事件中，353 例（59.5%）是潜在可预防的，123 例（20.7%）是明确或可能可预防的。最常见的不良事件与手术过程有关（n=292，49.3%），其次是药物不良事件（n=158，26.6%）、医院获得性感染（n=74，12.4%）、患者护理事件（n=66，11.2%）和输血反应（n=3，0.5%）。不良事件最常发生在普通病房（n=289，48.8%），其次是手术室（n=155，26.1%）、重症监护病房（n=77，13.0%）、恢复室（n=20，3.3%）、急诊部（n=11，1.8%）和其他院内地点（n=42，7.0%）。涉及的专业人员主要是主治医生（n=531，89.5%），其次是护士（n=349，58.9%）、住院医师（n=294，49.5%）、高级执业医师（n=169，28.5%）和研究员（n=68，11.5%）。
在因手术住院的患者中，超过三分之一的患者发生了不良事件，其中近一半的事件被归类为主要不良事件，且大多数是潜在可预防的。这些发现强调了在围手术期护理期间，所有卫生专业人员都需要持续不断地提高患者安全性，这是至关重要的。
