Preventable Morbidity and Mortality Among Non-trauma Emergency Surgery Patients: The Role of Personal Performance and Sy
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ORIGINAL SCIENTIFIC REPORT
Preventable Morbidity and Mortality Among Non-trauma Emergency Surgery Patients: The Role of Personal Performance and System Flaws in Adverse Events Constantine S. Velmahos1 • Nikolaos Kokoroskos2 • Constantine Tarabanis3 Haytham M. Kaafarani2 • Sanjay Gupta4 • Charudutt N. Paranjape4
•
Accepted: 25 October 2020 Ó Socie´te´ Internationale de Chirurgie 2020
Abstract Background Preventable morbidity and mortality among emergency surgery patients is not adequately analyzed. We aim to describe and classify preventable complications and deaths in this population. Methods The medical records and quality control documents of patients with emergency, non-trauma, surgical disease admitted between September 1, 2006, and August 31, 2018, and recorded to have a preventable or potentially preventable morbidity and mortality were reviewed. The primary outcome was a classification of the complications and deaths by a panel of experts, as attributable to issues of personal performance or system deficiencies. Results One hundred and fifty patients were identified (127 complications and 23 deaths). The most commonly encountered preventable complications were surgical-site infection (17%), bleeding (13%), injury to adjacent structures (12%), and anastomotic leak (8%). The majority of complications seemed to stem from personal performance (97%), due to either technical or judgment issues, and only 3% were linked with system flaws, either in the form of communication or inadequate protocols. Alcohol use disorder and duration of operation were different between patients with preventable adverse events related to technical issues and patients related to judgment issues; furthermore, more patients who experienced judgment issues died during hospital stay (p \0.05). Conclusion Among emergency surgery patients, who suffer preventable complications and deaths, issues related to personal performance are more frequent than system flaws. Whereas the effort to improve systems should be unwavering, the emphasis on the surgeon’s personal responsibility to avoid preventable complications should not be derailed.
Introduction
& Constantine S. Velmahos [email protected] 1
University of Massachusetts Medical School, Worcester, MA, USA
2
Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
3
Harvard Medical School, Boston, MA, USA
4
Department of Surgery, Newton-Wellesley Hospital, Newton, MA, USA
Several studies in the trauma surgery literature have shown that by understanding the nature of preventable complications, systems are developed to identify populations at risk and avoid related adverse events [1–3]. These rigorous, quality control systems have been widely reported to reduce morbidity and mortality across trauma centers [4, 5]. Whereas the causes and types of preventable complications have been exhaustively explored in the trauma literature, studies on preventable complications for nontraumatic emergency cases are sparse [6, 7].
123
World J Surg
Over the last two decades, non-trauma
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