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Objective: To test the correlation between severity of Intraoperative Adverse Events (iAEs) and thirty-day patient outcomes.
Design: A novel six-point severity scale of iAEs was recently derived and validated by our research team. Class I includes injuries requiring no or minimal repair (e.g. cauterization, use of pro-thrombotic material, small vessel ligation); class VI is intraoperative death. All patients entered in the ACS-NSQIP database from 2007 till 2012, flagged by the ICD-9-CM based Patient Safety Indicator “Accidental Puncture/Laceration (APL)”, and confirmed by systematic chart review to have an iAE were included. All iAEs were classified according to the severity scale. We tested the hypothesis that severe iAEs (Class III-V) were associated with worse thirty-day postoperative outcome than mild iAEs (Class I-II).
Setting: Tertiary academic medical center
Patients: ACS-NSQIP patients
Main Outcome Measure: Thirty-day postoperative complications
Results: Out of 9292 ACS-NSQIP patients, 264 were flagged by APL, and 181 iAEs were confirmed. All preoperative and intraoperative ACS-NSQIP variables, including demographics, co-morbidities, type of surgery performed and operative length were similar between patients with mild (n=110) vs. severe iAEs (n=71). In multivariate logistic analysis, severe iAEs were correlated with higher risks of any postoperative complication [OR 3.8 (CI 1.9-7.4), P<0.001], surgical site infection [OR 3.7 (1.7 - 8.2), p=0.001], systemic sepsis [6.0 (2.1 - 17.2), p=0.001], failure to wean off the ventilator in 48 hours [OR 3.2 (1.2 - 8.9), p=0.022], and length of stay ≥7 days [OR 3.0 (1.5 - 5.9), p= 0.002)]. Thirty-day mortalities were similar.
Conclusion: The severity of iAEs adversely affects thirty-day postoperative outcome. The proposed classification may prove useful for systematic severity-adjusted inter-hospital (and/or inter-surgeon) benchmarking of the quality of intraoperative surgical care.