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lite.cnn.com - on gopher - inofficial
ARTICLE VIEW:
More than 1 in 3 surgical patients has complications, study finds, and
many are the result of medical errors
By Brenda Goodman, CNN
Updated:
12:37 PM EST, Fri November 15, 2024
Source: CNN
Despite decades of calls for more attention to patient safety in
hospitals, people undergoing surgery still have high rates of
complications and medical errors, a new study finds.
More than a third of patients admitted to the hospital for surgery have
adverse events related to their care, and at least 1 in 5 of these
complications is the result of medical errors, the researchers found.
Studies delving into adverse events and medical errors in hospital
settings are few and far between, and each has slightly different
methods, so their results aren’t always an apples-to-apples
comparison. But the , which was published Thursday in the BMJ, fits
into a pattern of evidence going back decades, suggesting that
hospitals haven’t made much progress on patient safety.
“It’s pretty disturbing,” said Helen Haskell, an expert who
became a reluctant patient safety advocate after her son, Lewis
Blackman, died at the age of 15 following complications from surgery to
correct a condition called pectus excavatum, or a sunken chest. She
wrote that was published alongside the new study.
A medication her son was given to control pain caused a hole in his
digestive tract called a perforated ulcer, which led to internal
bleeding, an infection and septic shock. Haskell says she watched as
her previously healthy, athletic son deteriorated before her eyes.
“We couldn’t get anybody’s attention, and he just died. He was in
agony for 30 hours, and then he died,” she said.
If he had survived, she said, he would now be almost 40, something
that’s hard to think about.
After his death, Haskell founded the group Mothers Against Medical
Error, which promotes patient safety in hospitals.
Haskell says it’s frustrating to see continued harm to patients
related to the care they receive in hospitals.
“These are longstanding issues that are not really being properly
addressed, because I think they’re not as high in the consciousness
of either patients or health care providers as they should be,” she
said.
Groundbreaking research gets an update
For the new study, a team of researchers based at Harvard University
set out to copy the careful methods of the Harvard Medical Practice
Study, conducted in the 1980s that was one of the first to detail rates
of patient harm from health care. Its findings became the basis for a
from the National Academies of Sciences called “To Err is Human,”
which sounded the alarm on patient safety problems health care
settings.
“We’re trying to figure out, have things changed? Have they gotten
better?” said Dr. David Bates, a professor of health policy and
management at Harvard’s T.H. Chan School of Public Health, who led
the new research.
Since the original study, there have been important changes in
hospitals that are designed to make surgery safer. Electronic medical
records can send alerts, for example, if someone is prescribed two
medications that might have dangerous interactions. Surgeons also
routinely use presurgery checklists, something that wasn’t always
done four decades ago. There have also been campaigns to make doctors
and patients aware of stealthy conditions like sepsis that can quickly
turn deadly.
However, the new study found that safety issues persist.
“It’s clear that the problem has not gone away. If anything, it’s
even bigger than it was,” Bates said.
Bates says it’s hard to directly compare the findings of the older
Harvard study to the newer one because so much about health care
delivery itself has changed over the past 40 years. For the older
study, for example, the researchers combed through paper charts. This
time, they used electronic medical records.
Patients are different, too. In many cases, people in hospitals are
sicker than they used to be, and procedures have become riskier and
more complex, said Dr. Kedar Mate, president and CEO of the nonprofit
Institute for Healthcare Improvement, an organization that advocates
for patient safety.
Given this higher degree of difficulty, “the fact that our overall
adverse event rate is about the same as it was 20 years ago is in some
ways an accomplishment, even though the rate of harm is still far too
high and far too great,” said Mate, who was not involved with the new
study.
Akin Demehin, senior director of quality and patient safety at the
American Hospital Association, said hospitals and health systems are
continuously working to advance patient safety and quality. Demehin
pointed to from the US Centers for Disease Control and Prevention that
showed a decline in health care-associated infections.
Assessing harm in hospitals
The research looked at the outcomes of more than 1,009 people admitted
to 11 hospitals in Massachusetts in 2018 for surgery.
The researchers say this was the most recent data they could have
analyzed, given how long it took to get all the hospitals to agree to
participate (1½ years), collect all the records they needed (2 years),
have nurses review the records and identify potential adverse events (1
year). Doctors then spent another four months verifying the events and
ruling on whether these problems appeared to be preventable, according
to study researcher Dr. Antoine Duclos, who directs the Research on
Healthcare Performance Lab at Universite Claude Bernard in Lyon,
France.
Of the 1,009 surgical patients, 383 (38%) experienced at least one
adverse event. Roughly half of these events – 160 – were judged to
be serious or life-threatening, the study says.
More than 250 surgery patients, or about 1 in 4, had at least one
adverse even that was deemed to be potentially preventable, while 103,
or about 10%, had events that were judged to be definitely preventable
or the result of medical errors. By proportion of patients who had
adverse events, about 60% were determined to be potentially
preventable, and about 20% were ruled to be definitely preventable.
The most common types of complications were related to the surgery
itself, followed by medication errors and health care-associated
infections.
The risk of a complication increases with the patient’s age, the
study found, and with the type of procedure they had. Operations
involving the heart and lungs had the highest rates of complications,
followed by operations on the gut and digestive system, and procedures
involving the bones and joints.
These incidents most commonly happened outside the operating room,
usually once a patient had returned to their hospital room. They
include things like falls and pressure ulcers, Bates said.
Most hospitals have a policy of regularly reviewing cases where
patients were harmed with their doctors, but they do that for a tiny
fraction of the total, Bates added.
Bates said standard approaches for finding adverse events identify only
about 5% cases.
“It’s just a lot bigger problem than most hospitals recognize,”
he said.
Mate agrees. “It is high, and it is terrible, and it should be
alarming to everyone in the industry and that is paying attention.”
The study has some important limitations. All the hospitals that
participated were in Massachusetts, and even though researchers tried
to include hospitals of different sizes in different parts of the
state, it’s not clear whether these results would be the same in
other states or regions in the US.
The study authors also limited their focus to patients admitted to the
hospital for surgery. They may not apply to other settings, such as
outpatient surgery centers, which tend to handle less complex
procedures.
The study also relied on electronic medical records, which are prone to
errors, the researchers noted.
Still, advocates say the study should put renewed focus on patient
safety.
Bates says that reducing surgical complications is a job for hospitals
and doctors but that there are things patients can do to lower their
risk of complications.
“It’s useful, for example, to know what medications you’re taking
and to keep track of what the dosages are,” he said.
It’s also a good idea to bring someone with you to the hospital if
you’re going in for surgery.
“Often, people who are in the hospital are not that mentally
alert,” Bates said, “They’re not their usual self or in pain. And
so having someone else, either a friend or a loved one, there can be
really helpful.”
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