Key result
The 8 most common surgical procedures had a 50% lower adverse event incidence compared with overall cases, but their incidence increased by 56.0% and burden per case increased by 48.0% over 4 years.
Why the study?
Postoperative adverse events impose unanticipated stress on patients and unreimbursed costs on healthcare systems, prompting an evaluation of adverse event trends and severity using Clavien-Dindo gradation over time.
Observational (n=12,567)
Yes
Combining NSQIP adverse event data with Clavien-Dindo severity scores reveals that while common surgical procedures have lower overall adverse event rates, their complication burden has increased over time, highlighting areas for targeted quality improvement.
Adverse event burden rose in common procedures; hypothesis-generating for targeted safety monitoring in observational data.
OBJECTIVE: The burden of postoperative adverse events (AE) weighs immediately on the patient as unanticipated stress and on the healthcare system as unreimbursed cost. Applying the Clavien-Dindo (C-D) system of AE gradation as a surrogate of cost, we analyzed 4 years' data from a single-state National Surgical Quality Improvement Program (NSQIP) collaboration, hypothesizing that trends of AE were consistent over time and that more frequently performed cases would be associated with less and more minor AE. METHODS: The NSQIP defined AEs, consisting of 21 listed postoperative occurrences, which were analyzed using deidentified 30-day postoperative data for 2015 to 2018. Each AE was graded using (C-D) severity (1, lowest; 4, highest with survival). The C-D severity weight, as defined in previous multi-institutional studies, was used as a surrogate for cost and unplanned patient burden. Adverse event incidence was calculated as sum AE/case volume, and population burden as total AE burden/case volume. RESULTS: There were 12,567 surgical cases recorded by members of the state collaborative. The overall data demonstrated no significant difference in AE incidence; however, the burden of AE increased by 18.8%. The 8 most common Current Procedural Terminology codes had approximately 50% lower AE incidence compared with overall cases; however, the incidence increased by 56.0% and the AE burden/case increased by 48.0%. CONCLUSIONS: Although the 8 most common Current Procedural Terminology codes showed a 50% lower AE incidence compared with overall cases, the incidence increased over the study period. Surgical quality initiatives should be patient centered and focus on high burden AE.
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A 2022 study conducted an observational in Postoperative adverse events in surgical patients (n=12,567). 8 most common Current Procedural Terminology codes vs. Overall surgical cases was evaluated on Adverse event incidence and population burden. The 8 most common surgical procedures had a 50% lower adverse event incidence compared with overall cases, but their incidence increased by 56.0% and burden per case increased by 48.0% over 4 years.
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