The cost of misadventures in colonic surgery. A model for the analysis of adverse outcomes in standard procedures.

Analysis revealed an impressive number of patients transferred to intensive care at the Peter Bent Brigham Hospital after misadventures in standard medical and surgical procedures. The model explored here is that of colon surgery, a therapy standardized for decades. The courses of sixteen patients were studied, wherein adverse outcomes appeared to have been preventable. Failure to diagnose colonic leakage and failure to provide colostomy (or to do so safely) were the major underlying causes. Nephrotoxic antibiotics and immunosuppression were sometimes in the background. Nine patients died, all with severe sepsis. Multiple organ failure occurred in the majority of cases. The mortality was tenfold, the cost sevenfold, and the length of hospitalization fourfold that expected after uneventful operation. Current interest in cost-benefit analysis should be broadened standard medical and surgical procedures. Litigious potential should not be allowed to impede such analyses.