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Chiropractic Research Review

Studying Surgical Iatrogenesis to Improve Care

Surgical adverse events - negative outcomes or complications resulting from surgical management - have been characterized as "not infrequent and often avoidable." The Harvard Medical Practice Study (completed in the early 1990s) found that operative adverse events accounted for 48% of all adverse events, occurred in approximately 2% of all hospitalized patients, and were preventable 74% of the time.

The current study examined the incidence of adverse surgical events by evaluating 15,000 discharges from a sample of hospitals in Colorado and Utah in 1992. Examples of adverse events included technique-related complications, postoperative bleeding, wound infection and deep vein thrombosis. Events were characterized by type of injury, physician specialty, and type of surgical procedure.

Results: Sixty-six percent of all adverse events were of a surgical nature, amounting to 3% of adverse events experienced annually among hospitalized patients undergoing an operation or child delivery. Among all surgical adverse
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events, 5.6% resulted in death. Technique-related complications accounted for nearly 25% of all adverse surgical events; drug-related errors, diagnostic errors and errors in choice of therapy accounted for 12% of such events. Among 12 common operations, six were found to have significantly elevated adverse event incidence rates:

* abdominal aortic aneurysm repair;
* lower extremity bypass graft;
* coronary artery bypass graft;
* colon resection;
* cholecystectomy; and
* prostatectomy.

The authors estimate that overall, 54% of these adverse events were/are preventable, and urge for future research "to identify the causes of adverse surgical events and for targeted quality improvement efforts."

Gawande AA, Thomas EJ, Zinner MJ, et al. The incidence and nature of surgical adverse events in Colorado and Utah in 1992. Surgery 1999:126(1), pp66-75.

Chiropractic Research Review

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