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Are Surgeons Reluctant to Accurately Report Intraoperative Adverse Events? A Prospective Study of 1,989 Patients
*Thomas Peponis, *Josefine S. Baekgaard, *Jordan D. Bohnen, *Kelsey Han, *Jarone Lee, *Noelle Saillant, *Daniel D. Yeh, *Peter J. Fagenholz, *David R. King, *Marc A. de Moya, George C. Velmahos, Haytham M.A. Kaafarani
Massachusetts General Hospital, Boston, MA

Objective: The true incidence of intraoperative adverse events (iAEs) remains unknown. We aimed to evaluate whether surgeons are willing to voluntarily and accurately report iAEs. Design: Prospective cohort. Setting: Tertiary academic center. Patients: All patients undergoing abdominal surgery between January and July 2016 were included. At the end of surgery, using a secure REDCap database, the surgeon was given the Institute of Medicine definition of iAE and asked whether an iAE occurred. Blinded reviewers then systematically examined all operative reports for iAEs. Main Outcome Measures: The response rate and the iAE rate reported by surgeons were calculated. The latter was compared to the rate of iAEs detected by operative report review. The severity of iAEs was assessed based on a previously validated iAE classification system. Results: A total of 1,989 operations were included. The surgeonsí response rate was 72%, reporting iAEs in 107 operations (7.5%). Of those iAEs, 26 (24.3%) were not described in the operative report. The operative report review revealed iAEs in 417 operations (21%). The surgeonsí response rate was similar in operations with and without iAEs (70% versus 72%, p=0.28), but they underreported low severity iAEs. Table 1 shows that surgeons reported only 13.2% of class I compared to 35.3%, 36.8%, and 55.6% of injury classes II, III, and IV respectively (p<0.001). Conclusions: Surgeons systematically underreported iAEs especially those of lower severity. This is potentially related to the absence of a clear iAE definition and/or their personal interpretation of their clinical significance.

Table 1.
Class*DescriptioniAEs per Operative Report Review, NiAEs Reported by Surgeons, n/N (%) **
IInjury requiring no repair within the same procedure (e.g., small vessel ligation)27336/273 (13.2)
IIInjury requiring surgical repair, without organ removal or a change in the originally planned procedure (eg, any suture repair)8530/85 (35.3)
IIIInjury requiring tissue or organ removal with completion of the originally planned procedure197/19 (36.8)
IVInjury requiring a significant change and/or incompletion of the originally planned procedure95/9 (55.6)
VMissed intraoperative injury requiring re-operation within 7 days270/27 (0)
VIIntraoperative death43/4 (75.0)
* Derivation and validation of a novel severity classification for intraoperative adverse events. J Am Coll Surg. 2014; 218(6): 1120-8. ** Of the 107 iAEs that were reported by surgeons, 26 were not described in the operative reports.


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