A decade-long overview of adverse events in a tertiary surgical service in South Africa
DOI:
https://doi.org/10.7196/SAMJ.2024.v114i10.2035Keywords:
adverse event, complication, patient safetyAbstract
Background. Adverse events are common, and impact patients and healthcare systems negatively. Large international systems investigate adverse events at length, but South African data are lacking.
Objectives. To classify all adverse events that have occurred in our department over the last decade.
Methods. Ten years of data from a prospectively collated electronic medical record system were analysed for adverse events. All admitted patients were included. Duplicate entries and those that did not describe adverse events were excluded.
Results. The study period was from December 2012 to January 2023. There were 52 835 distinct admissions covering 321 385 inpatient days. After categorisation, a total of 14 537 adverse events were captured, giving an adverse event rate of 22%. Adverse events were categorised into four groups. Of the total, 8 027 events were clinical care related, 3 106 were pathology related, 2 662 were system related and 442 miscellaneous. A total of 300 were excluded. Clinical care-related adverse events comprised 57.3% of the total number. Of those, adverse events related to indwelling devices (32.4%), iatrogenic injuries (12.5%) and intravenous therapy administration (12.5%) contributed most. Pathology-related adverse events contributed 21.4% of the total, of which wound sepsis (29.5%), anastomotic leak (15.1%) and nosocomial pneumonia (14.4%) were the most common. There was a general downward trend in reported adverse events from 2016 to 2022.
Conclusion. Adverse events are common, and their aetiology is multifactorial. A sustained and multi-faceted approach is needed to address the challenge they pose.
References
1. Reason J. Understanding adverse events: Human factors. BMJ Qual Safety 1995;4(2):80-89. https://doi.org/10.1136/qshc.4.2.80 2. Donaldson MS, Corrigan JM, Kohn LT. To Err is Human: Building a Safer Health System. Washington, DC: National
Academies Press, 2000.
3. Rafter N, Hickey A, Condell S, et al. Adverse events in healthcare: Learning from mistakes. Int J Med 2015;108(4):273-
277. https://doi.org/10.1093/qjmed/hcu145
4. Shojania KG, Thomas EJ. Trends in adverse events over time: Why are we not improving? BMJ 2013:22(4):273-277. https://
doi.org/10.1136/bmjqs-2013-001935
5. Sari AB-A, Sheldon TA, Cracknell A, et al. Extent, nature and consequences of adverse events: Results of a retrospective casenote review in a large NHS hospital. Qual Safety Health Care 2007;16(6):434-439. https://doi.org/10.1136/qshc.2006.021154
6. Acevedo E Jr., Kuo LE. The economics of patient surgical safety. Surg Clin North Am 2021;101(1):135-148. https://doi. org/10.1016/j.suc.2020.09.005
7. Proctor ML, Pastore J, Gerstle JT, Langer JC. Incidence of medical error and adverse outcomes on a pediatric general surgery service. J Pediatric Surg 2003;38(9):1361-1365. https:// doi.org/10.1016/S0022-3468(03)00396-8
8. Fuchshuber PR, Greif W, Tidwell CR, et al. The power of the National Surgical Quality Improvement Program – achieving a zero pneumonia rate in general surgery patients. Perm J 2012;16(1):39-45. https://doi.org/10.7812/tpp/11-127
9. Smith MTD, Bruce JL, Clarke DL. Health-related behaviours, HIV and active tuberculosis are associated with perioperative adverse events following emergency laparotomy at a tertiary surgical service in KwaZulu-Natal, South Africa. World J Surg 2021;45(6):1672-1677. https://doi.org/10.1007/s00268-021- 05986-9
10. Smith MTD, Clarke DL. Spectrum and outcome of emergency general surgery laparotomies at a tertiary center in South Africa. J Surg Res 2021;262:65-70. https://doi.org/10.1016/j. jss.2020.12.062
11. Rode H, Brink C, Martinez R, Bester K, Coleman M, Baisey T. A review of the peri-operative management of paediatric burns: Identifying adverse events. S Afr Med J 2016;106(11):1114-1119. https://doi.org/10.7196/SAMJ.2016.v106i11.10938
12. Spence RT, Hampton M, Pluke K, et al. Factors associated with adverse events after emergency laparotomy in Cape Town, South Africa: Identifying opportunities for quality improvement. J Surg Res 2016;206(2):363-370. https://doi.org/10.1016/j. jss.2016.08.025
13. Wain H, Kong V, Bruce J, Laing G, Clarke D. Analysis of surgical adverse events at a major university hospital in South Africa. World J Surg 2019;43(9):2117-2122. https://doi.org/10.1007/ s00268-019-05008-9.
14. Wain H, Wall S, Clarke D. Adverse events associated with the use of indwelling devices in surgical patients. S Afr J Surg 2023;61(4):184-188. https://doi.org/10.36303/SAJS.4019
15. Leape LL, Brennan TA, Laird N, et al. The nature of adverse events in hospitalised patients: Results of the Harvard Medical Practice Study II. N Eng J Med 1991;324(6):377-384. https://doi. org/10.1056/NEJM199102073240605
16. Rebasa P, Mora L, Luna A, Montmany S, Vallverdú H, Navarro S. Continuous monitoring of adverse events: Influence on the quality of care and the incidence of errors in general surgery. World J Surg 2009;33:191-198. https://doi.org/10.1007/s00268- 008-9848-6
17. Rebasa P, Mora L, Vallverdú H, et al. Adverse events in general surgery. A prospective analysis of 13 950 consecutive patients. Cirugía Española (English ed.) 2011;89(9):599-605. https://doi. org/10.1016/j.cireng.2011.06.005
18. Bruce J, Russell EM, Mollison J, Krukowski ZH. The measurement and monitoring of surgical adverse events. Health Tech Assess 2001:1-194. https://www.researchgate.net/profile/Z-Krukowski/ publication/11814436_The_measurement_and_monitoring_ of_surgical_adverse_events/links/00b7d5273d4cd65af0000000/ The-measurement-and-monitoring-of-surgical-adverse-events. pdf (accessed 12 September 2024).
19. Kable A, Gibberd R, Spigelman A. Adverse events in surgical patients in Australia. Int J Qual Health Care 2002;14(4):269-276. https://doi.org/10.1093/intqhc/14.4.269
20. Andrews LB, Stocking C, Krizek T, et al. An alternative strategy for studying adverse events in medical care. Lancet 1997;349(9048):309-313. https://doi.org/10.1016/S0140- 6736(96)08268-2
21. Anderson O, Davis R, Hanna GB, Vincent CA. Surgical adverse events: A systematic review. Am J Surg 2013;206(2):253-262. https://doi.org/10.1016/j.amjsurg.2012.11.009
22. Michel P, Quenon JL, de Sarasqueta AM, Scemama O. Comparison of three methods for estimating rates of adverse events and rates of preventable adverse events in acute care hospitals. BMJ 2004;328(7433):199. https://doi.org/10.1136/ bmj.328.7433.199
23. Beesoon S, Sydora BC, Thanh NX, et al. Does the introduction of American College of Surgeons NSQIP improve outcomes? A systematic review of the academic literature. J Am Coll Surg 2020;231(6):721-739e8. https://doi.org/10.1016/j. jamcollsurg.2020.08.773
24. Cohen ME, Liu Y, Ko CY, Hall BL. Improved surgical outcomes for ACS NSQIP hospitals over time. Ann Surg 2016;263(2):267- 273. https://doi.org/10.1097/SLA.0000000000001192
25. Zhang JX, Song D, Bedford J, Bucevska M, Courtemanche DJ, Arneja JS. What is the best way to measure surgical quality? Comparing the American College of Surgeons National Surgical Quality Improvement Program versus traditional morbidity and mortality conferences. Plast Reconstruct Surg 2016;137(4):1242- 1250. https://doi.org/10.1097/01.prs.0000481737.88897.1a
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