Adverse events impact over one-third (38%) of adult surgical patients, according to a survey of 1,009 admissions to 11 hospitals in Massachusetts published in The BMJ.
Nearly half of these events were classified as major – causing serious, life-threatening, or fatal harm – and most were deemed preventable.
The findings emphasise the need for continued improvements in patient safety.
The researchers note: ‘Adverse events remain widespread in contemporary healthcare, causing substantial and preventable patient harm during hospital admission.’
Adverse events are defined as negative effects of treatment, such as complications from surgery or medication errors, and represent a significant cause of patient harm during hospitalisation.
Since the 1991 Harvard Medical Practice Study exposed the prevalence of unintended injuries in medical care, surgical advancements such as minimally invasive techniques, safety checklists, and enhanced recovery protocols have aimed to reduce harm.
However, the current study highlights the persistent need to assess surgical safety and establish updated benchmarks for quality improvement.
The study involved a randomly selected sample of patients aged 18 and older admitted for surgery in 2018.
The hospitals represented a mix of large and small facilities across three healthcare systems, and estimates were adjusted to account for population differences. Trained nurses reviewed patient records to identify possible adverse events, which physicians confirmed and categorised.
Adverse events were deemed major if they required significant intervention or prolonged recovery, were life-threatening, or resulted in death. The researchers also assessed the severity and preventability of events by type, setting, and the professionals involved.
Of the 1,009 admissions reviewed (average age 61, 52% women), 383 cases (38%) had adverse events, and 160 cases (16%) had major events.
Of the 593 identified adverse events, 60% (353) were potentially preventable, and 21% (123) were definitely or probably preventable.
The most frequent adverse events were related to surgical procedures (49%), followed by adverse drug events (27%), healthcare-associated infections (12%), patient care events like falls or pressure ulcers (11%), and blood transfusion reactions (0.5%).
The majority of events occurred in general care units (50%), followed by operating rooms (26%), intensive care units (13%), and other in-hospital locations (7%).
Attending physicians (90%), nurses (59%), residents (50%), and advanced-level practitioners (29%) were the professions most often involved.
Despite the study’s strengths, the authors acknowledge limitations.
The findings are based on data from Massachusetts in 2018 and may not be generalisable to other healthcare settings. Also, some events now considered preventable might not have been viewed as such at the time of care.
The study underscores that adverse events are not confined to operating rooms.
In a linked editorial, Helen Haskell, president of Mothers Against Medical Error, questions why patient safety has improved little despite decades of efforts. She cites factors such as a culture of disrespect, insufficient nurse staffing, and the underuse of real-time error detection and prevention technologies.
‘All undoubtedly have played a part,’ Haskell writes, but she argues that the lack of progress also reflects the limited involvement of patients and families in addressing errors.
‘If we are truly interested in advancing patient safety, patients and families need to be empowered to weigh in on the accuracy of the accounts of their care and participate in finding solutions,’ she added.
