Key result
Among VA outpatient surgeries selected based on likelihood of an adverse event, 33% of cases had at least one adverse event, with nearly 40% of identified events carrying more than minimal patient harm.
Observational (n=2,257)
Yes
Nearly 40% of identified adverse events in select VA outpatient surgeries carried more than minimal patient harm, undermining the assumption that outpatient surgery is uniformly safe.
Answers are grounded in this paper and cite their sources.
Selected VA outpatient surgeries reveal notable harm; challenges uniform safety assumptions yet leaves open generalizability to routine practice.
BACKGROUND: Research on adverse events (AEs) in outpatient surgery has been limited. As part of a Veterans Health Administration (VA) project on AE surveillance, we chart-reviewed selected outpatient surgical cases to characterize the nature and severity of AEs. METHODS: We abstracted financial year 2012-2015 VA outpatient surgery cases selected with high (n = 1185) and low (n = 1072) likelihood of an AE based on postoperative health care utilization. The abstraction tool included established AE definitions and validated harm and severity scales. RESULTS: We found AEs in 608 high-likelihood (51%) and 126 low-likelihood outpatient surgical procedures (12%). Among 1010 unique AEs, the most common were wound issues (n = 261, 26%), urinary retention (23%), and urinary tract infections (12%). While 63% of all AEs involved minimal harm, 28% required hospitalization, and 9% were severely harmful including 8 AEs requiring intervention to sustain life and 2 deaths. Overall, 102 AEs (10%) required, at minimum, a repeat surgery to treat. CONCLUSIONS: Among VA outpatient surgical procedures selected based on likelihood of an AE, nearly 40% of identified events carried more than minimal patient harm, undermining the claim that outpatient surgery is relatively safe. Prevalent and preventable AEs such as wound dehiscence and urinary retention may be useful targets for quality improvement.
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Mull et al. (2018) conducted an observational in Outpatient surgery adverse events (n=2,257). Outpatient surgery was evaluated on Nature and severity of adverse events. Among VA outpatient surgeries selected based on likelihood of an adverse event, 33% of cases had at least one adverse event, with nearly 40% of identified events carrying more than minimal patient harm.
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